Metformin was not effective in reducing BMI and preventing GDM in obese pregnant women.

Objective: To evaluate the use of metformin for preventing cesarean deliveries and large-forgestational-age (LGA) newborn (NB) outcomes in non-diabetic obese pregnant women. Subjects and methods: This is a randomized clinical trial with obese pregnant women, divided into 2 groups: metformin group and control group, with followed-up prenatal routine. The gestational age of participants was less than or equal to 20 weeks and were monitored throughout entire prenatal period. For outcomes of delivery and LGA newborns, absolute risk reduction (ARR) and the number needed to treat (NNT) were calculated with a 95% confidence interval (CI). Results: 357 pregnant women were evaluated. From the metformin group (n = 171), 68 (39.8%) subjects underwent cesarean delivery, and 117 (62.9%) subjects from the control group (n = 186) had intercurrence (p < 0.01). As for the mothers' general characteristics, there was significance for marital status (p < 0.01). Maternalfetal results presented reduced preeclampsia (p < 0,01). Primary prophylactic results presented an ARR of 23.1 times (95% CI: 13.0-33.4) with NNT of 4 (95% CI: 3.0-7.7) and no significant values for LGA NB (p > 0.01). Secondary prophylactic outcomes presented decreased odds ratio for preeclampsia (OR = 0.17, 95% CI: 0.10-0.41). Conclusion: The use of metformin reduced cesarean section rates, resulted in a small number of patients to be treated, but it did not reduce LGA NB. Administering a lower dosage of metformin from the early stages to the end of treatment may yield significant results with fewer side effects.

Objective To evaluate the factors associated with the need for insulin as a complementary treatment to metformin in pregnant women with gestational diabetes mellitus (GDM). Methods A case-control study was performed from April 2011 to February 2016 with pregnant women with GDM who needed complementary treatments besides diet and physical exercise. Those treated with metformin were compared with those who, in addition to metformin, also needed the combination with insulin. Maternal characteristics and glycemic control were evaluated. Multinomial logistic regression models were developed to evaluate the influence of different therapies on neonatal outcomes. Results A total of 475 pregnant women who needed pharmacological therapy were evaluated. Of these, 366 (77.05%) were submitted to single therapy with metformin, and 109 (22.94%) needed insulin as a complementary treatment. In the analysis of the odds ratio (OR), fasting glucose (FG) < 90 mg/dL reduced the odds of needing the combination (OR: 0.438 [0.235–0.815]; p = 0.009], as well as primiparity (OR: 0.280 [0.111–0.704]; p = 0.007]. In obese pregnant women, an increased chance of needing the combination was observed (OR: 2,072 [1,063–4,039]; p = 0,032). Conclusion Obesity resulted in an increased chance of the mother needing insulin as a complementary treatment to metformin, while FG < 90 mg/dL and primiparity were protective factors.

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The meningococcal disease manifestation associated with the presence of Cryptococcus neoformans is rare. There are no reports in the literature about these simultaneous infections in immunocompetent patients. The aim of the present study is to describe the first case of fulminant septic shock by Neisseira meningitidis associated with Cryptococcus neoformans coinfection in an immunocompetent patient. We describe a case of an immunocompetent 74-year-old Caucasian woman who presented with fulminant acute meningococcemia associated with cryptococcal meningitis, which progressed to worsening general condition and died of septic shock and multiple organ dysfunctions in less than 48 hours. This case report demonstrates the possibility of coinfections related to Neisseria meningitidis and Cryptococcus neoformans, even in immunocompetent patients, which represent a diagnostic challenge for clinicians, thus encouraging further studies for a better understanding.

RESUMO:Quais são os resultados preponderantes com a administração do cloridrato de metformina no índice de massa corporal elevado da gestante e no peso do recém-nascido? Foi feita uma revisão sistemática da literatura selecionada entre os anos de 2000 a 2017 sobre a obesidade e os efeitos da terapia na gestação nas bases MEDLINE, LILA-CS, Embase e Cochrane. Analisou-se artigos disponíveis em meio eletrônico, publicados em português, espanhol e inglês. Dentre os 2.127 artigos inicialmente escolhidos, somente 29 estudos estavam dentro dos critérios estabelecidos. Os desfechos avaliados foram resultados da terapia metformina versus placebo, terapia metformina versus insulina e o impacto de diferentes dosagens de metformina utilizadas nas pesquisas. A medicação apresentou resultados relevantes na redução do peso da mãe, mas não o do recém-nascido. Novos estudos clínicos multicêntricos são necessários, bem como uma estratégia terapêutica inovadora quanto às dosagens do cloridrato de metformina durante os três trimestres da gravidez. PALAVRAS-CHAVE:Metformina; Gravidez; Obesidade; Recém-nascido. THE EFFECTS OF METFORMIN ON GESTATIONAL OBESIT Y AND NEWBORN WEIGHTABSTRACT: Which are the most predominant results with the administration of metformin hydrochloride in the high body mass index of the pregnant and in the newborn's weight? A systematic review of the literature choose from 2000 to 2017 on obesity and the effects of therapy on pregnancy in MEDLINE, LILACS, Embase and Cochrane databases was performed. Among the 2,127 papers initially chosen, only 29 studies presented the criteria established. The outcomes assessed were results of the metformin therapy versus placebo, metformin therapy versus insulin, and the impact of different dosages of metformin used in the researches. The drug presented relevant results in reducing the weight of the mother, but not the newborn. New multi-centre clinical studies are needed as well as an innovative therapeutic strategy regarding the dosages of metformin hydrochloride during the three quarters of pregnancy. KEY WORDS:Metformin; Pregnancy; Obesity; Newborn. INTRODUÇÃOO índice de obesidade na população mundial vem aumentando progressivamente. Em 2015 estimou-se 42 milhões de crianças Iramar Baptistella do Nascimento

Objetivos: o artigo objetiva avaliar o uso de metformina em gestantes obesas na prevenção da pré-eclâmpsia.Métodos: trata-se de um ensaio clínico randomizado com mulheres grávidas obesas com índice de massa corporal superior ou igual a 30 kg/m2 divididos em dois grupos – um grupo de estudo, que utilizou metformina, e um grupo controle, que seguiu a rotina de pré-natal. As gestantes entraram no estudo com idade gestacional menor que 20 semanas e foram acompanhadas durante todo o período pré-natal. O diagnóstico de pré-eclâmpsia foi feito de acordo com os critérios da Organização Mundial de Saúde.Resultados: verificou-se a redução de risco absoluto e o número necessário para tratar em um intervalo de confiança de 95% para o resultado pré-eclâmpsia. Nos resultados, 272 gestantes foram avaliadas. No grupo de estudo (n = 127), oito (6,3%) desenvolveram pré-eclâmpsia. No grupo controle (n = 145), 31 (21,4%) tiveram a doença (p <0,01).Conclusão: o estudo apontou uma redução de risco absoluto de 15,1 vezes (IC95%: 7,1-22,9) e número necessário para tratar de sete (IC95%: 4,4-13,9). O uso de 1000 miligramas diárias de metformina indicou uma redução de 15,1 vezes no risco absoluto de pré-eclâmpsia na população estudada, com a necessidade de tratar sete gestantes para evitar um desfecho.