Metformin for Gestational Diabetes Mellitus: Progeny, Perspective, and a Personalized Approach

Barbour, Linda A.; Feig, Denice S.

doi:10.2337/dci18-0055

Cited by 31 publications

(30 citation statements)

References 52 publications

(49 reference statements)

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“…However, metformin-exposed children were reported to have an increased prevalence of overweight or obesity at 4 years of age [30]. Interpretation of these follow-up data is difficult, given that postnatal factors might significantly influence obesity risk in children [22].…”

Section: Discussionmentioning

confidence: 99%

“…The popularity of metformin use during pregnancy in this study might result from the ease of use of this oral agent, the emergence of promising safety profiles for metformin use in pregnancy, and needle phobia [ 4 ]. The rising cost of insulin is one of the reasons supporting the use of metformin as an alternative to insulin during pregnancy [ 22 – 26 ]. However, NHI provides reimbursements for insulin and insulin is inexpensive in Taiwan [ 27 ]; therefore, affordability may not account for the frequent use of metformin in this study.…”

Section: Discussionmentioning

confidence: 99%

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Association of pregnancy outcomes in women with type 2 diabetes treated with metformin versus insulin when becoming pregnant

Lin

Chang

Kuo

et al. 2020

BMC Pregnancy Childbirth

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Background: Metformin use in pregnancy is controversial because metformin crosses the placenta and the safety on the fetus has not been well-established. This retrospective study aimed to compare pregnancy outcomes in women with preexisting type 2 diabetes receiving metformin or standard insulin treatment. Methods: The cohort of this population-based study includes women of age 20-44 years with preexisting type 2 diabetes and singleton pregnancies in Taiwan between 2003 and 2014. Subjects were classified into three mutually exclusive groups according to glucose-lowering treatments received before and after becoming pregnant: insulin group, switching group (metformin to insulin), and metformin group. A generalized estimating equation model adjusted for patient age, duration of type 2 diabetes, hypertension, hyperlipidemia, retinopathy, and aspirin use was used to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) of adverse pregnancy outcomes. Results: A total of 1166 pregnancies were identified in the insulin group (n = 222), the switching group (n = 318) and the metformin group (n = 626). The insulin group and the switching group had similar pregnancy outcomes for both the mother and fetus, including risk of primary cesarean section, pregnancy-related hypertension, preeclampsia, preterm birth (< 37 weeks), very preterm birth (< 32 weeks), low birth weight (< 2500 g), high birth weight (> 4000 g), large for gestational age, and congenital malformations. The metformin group had a lower risk of primary cesarean section (aOR = 0.57; 95% CI, 0.40-0.82) and congenital malformations (aOR, 0.51; 95% CI; 0.27-0.94) and similar risk for the other outcomes as compared with the insulin group. Conclusions: Metformin therapy was not associated with increased adverse pregnancy outcomes in women with type 2 diabetes as compared with standard insulin therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of pregnancy outcomes in women with type 2 diabetes treated with metformin versus insulin when becoming pregnant

Lin

Chang

Kuo

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

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“…Moreover, additional clarity is needed regarding their clinical impact on varied outcomes (e.g., GDM, HDP, excessive gestational weight gain, large for gestational age) and the long-term effects on offspring. 23 While the study we critically reviewed regarding lifestyle intervention (diet, monitoring, AE insulin as indicated) demonstrated no statistical impact on HDP in pregnant women with a first trimester hemoglobin A1c in the prediabetes range, it was small and underpowered. 13 However, this result is consistent with prior findings of lifestyle intervention in pregnancy which demonstrate a reduced risk for GDM but not preeclampsia.…”

Section: Discussionmentioning

confidence: 99%

Review of Prediabetes and Hypertensive Disorders of Pregnancy

Carris

Nwabuobi

et al. 2019

Am J Perinatol

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Obesity and diabetes increase hypertensive disorders of pregnancy (HDP) risk, thus preventive interventions are heavily studied. How pregestational prediabetes and related interventions impact HDP risk is less characterized. Therefore, we searched and reviewed the literature to assess the impact on HDP risk of prediabetes and varied interventions. We identified 297 citations related to pregnancy, prediabetes, and early pregnancy interventions. We also reviewed the references and citations of included articles. We included five studies assessing HDP outcomes in women with first trimester hemoglobin A1c in the prediabetes range (5.7–6.4%). One prospective observational study demonstrated first trimester hemoglobin A1c (5.9–6.4%) is associated with increased HDP risk, while another prospective observational study and one retrospective observational study had similar trends without statistical significance. A small and underpowered randomized controlled trial demonstrated initiating gestational diabetes mellitus treatment (i.e., diet, monitoring, ± insulin) in response to first trimester hemoglobin A1c (5.7–6.4%) did not statistically reduce HDP compared with standard care. One retrospective observational study suggested metformin, when started early, may reduce HDP risk in patients with prediabetes. Pregestational prediabetes appears to increase HDP risk. Interventions (i.e., metformin, diet/glucose monitoring, and/or exercise) to reduce HDP risk require additional study with long-term follow-up.

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“…Oral agents may be an alternative in these women after a discussion of the known risks and the need for more long-term safety data in offspring. However, due to the potential for growth restriction or acidosis in the setting of placental insufficiency, metformin should not be used in women with hypertension, preeclampsia, or at risk for intrauterine growth restriction (78,79).…”

Section: Metforminmentioning

confidence: 99%

14. Management of Diabetes in Pregnancy:Standards of Medical Care in Diabetes—2020

2019

Diabetes Care

295

148

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The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidencegrading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. DIABETES IN PREGNANCY The prevalence of diabetes in pregnancy has been increasing in the U.S. in parallel with the worldwide epidemic of obesity. Not only is the prevalence of type 1 diabetes and type 2 diabetes increasing in women of reproductive age, but there is also a dramatic increase in the reported rates of gestational diabetes mellitus. Diabetes confers significantly greater maternal and fetal risk largely related to the degree of hyperglycemia but also related to chronic complications and comorbidities of diabetes. In general, specific risks of diabetes in pregnancy include spontaneous abortion, fetal anomalies, preeclampsia, fetal demise, macrosomia, neonatal hypoglycemia, hyperbilirubinemia, and neonatal respiratory distress syndrome, among others. In addition, diabetes in pregnancy may increase the risk of obesity, hypertension, and type 2 diabetes in offspring later in life (1,2). PRECONCEPTION COUNSELING Recommendations 14.1 Starting at puberty and continuing in all women with diabetes and reproductive potential, preconception counseling should be incorporated into routine diabetes care. A 14.2 Family planning should be discussed, and effective contraception (with consideration of long-acting, reversible contraception) should be prescribed and used until a woman's treatment regimen and A1C are optimized for pregnancy. A 14.3 Preconception counseling should address the importance of achieving glucose levels as close to normal as is safely possible, ideally A1C ,6.5% (48 mmol/mol), to reduce the risk of congenital anomalies, preeclampsia, macrosomia, and other complications. B All women of childbearing age with diabetes should be informed about the importance of achieving and maintaining as near euglycemia as safely possible prior Suggested citation: American Diabetes Association. 14. Management of diabetes in pregnancy:

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Metformin for Gestational Diabetes Mellitus: Progeny, Perspective, and a Personalized Approach

Cited by 31 publications

References 52 publications

Association of pregnancy outcomes in women with type 2 diabetes treated with metformin versus insulin when becoming pregnant

Association of pregnancy outcomes in women with type 2 diabetes treated with metformin versus insulin when becoming pregnant

Review of Prediabetes and Hypertensive Disorders of Pregnancy

14. Management of Diabetes in Pregnancy:Standards of Medical Care in Diabetes—2020

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