Metformin Use in PCOS Pregnancies Increases the Risk of Offspring Overweight at 4 Years of Age: Follow-Up of Two RCTs

Hanem, Liv Guro Engen; Stridsklev, Solhild; Júlíusson, Pétur Benedikt; Salvesen, Øyvind; Roelants, Mathieu; Carlsen, Sven Magnus; Ødegård, Rønnaug; Vanky, Eszter

doi:10.1210/jc.2017-02419

Cited by 151 publications

(128 citation statements)

References 39 publications

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“…Nadalje, gotovo polovici trudnica s GDM-om koje su u početku liječene metforminom treba terapija inzulinom za postizanje zadovoljavajuće glukoregulacije 31 . Ipak, ono što najviše zabrinjava kada je u pitanju primjena metformina u trudnoći, jesu podaci koji ukazuju na veću pojavnost debljine u djece čije su majke tijekom trudnoće uzimale metformin 32,33 .…”

Section: Oralni Antihiperglikemiciunclassified

Novosti u liječenju gestacijskog dijabetesa

Hlača

Majanović

2019

Med. Flum. (Online)

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Sažetak. Gestacijski dijabetes (GDM) najčešći je metabolički poremećaj u trudnica povezan s neželjenim ishodima trudnoće i dugoročnim zdravstvenim rizicima za majke i njihovo potomstvo. Prevalencija GDM-a u svijetu raste zbog epidemije debljine, sve starije dobi trudnica i strožih dijagnostičkih kriterija. Promjena životnog stila temeljena na uravnoteženoj prehrani i prirast tjelesne mase unutar poželjnih okvira imaju vodeću ulogu u liječenju GDM-a. Ako glikemijske ciljeve nije moguće ostvariti samo dijetom, indicirana je terapija inzulinom s obzirom na to da za oralne antihiperglikemike još nema dovoljno podataka o dugoročnoj sigurnosti. Budući da žene s GDM-om imaju doživotni rizik za razvoj šećerne bolesti tipa 2, potrebno je redovito praćenje i probir na šećernu bolest 4 do 12 tjedana nakon poroda te potom svake 1 do 3 godine. Cilj ovog članka je prikazati novosti u liječenju gestacijskog dijabetesa.Abstract. Gestational diabetes (GDM) is the most common metabolic disorder in pregnant women associated with adverse pregnancy outcomes and long-term maternal and offspring health risks. Worldwide GDM prevalence is increasing in the setting of the obesity epidemic, advanced maternal age, and tighter diagnostic criteria. Lifestyle interventions that promote healthy eating behaviours and healthy weight gain play a key role in the management of GDM. If glycemic targets are not achieved with diet alone, insulin therapy is recommended since oral antihyperglycemic agents lack long-term safety data. Because GDM is associated with an increased lifetime maternal risk for type 2 diabetes women should be followed up regularly and screened for diabetes 4-to 12-weeks postpartum and every 1-3 years thereafter. The aim of this article is to present an update on treatment of gestational diabetes. * Dopisni autor: Doc. dr. sc. Sanja Klobučar Majanović, dr. med. Zavod za endokrinologiju, dijabetes i bolesti metabolizma, Klinika za internu medicinu, Klinički bolnički centar Rijeka, 1 Klinički bolnički centar Rijeka, Rijeka 2 Zavod za endokrinologiju, dijabetes i bolesti metabolizma, Klinika za internu medicinu, Klinički bolnički centar Rijeka i Medicinski fakultet Sveučilišta u Rijeci, Rijeka

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Section: Oralni Antihiperglikemiciunclassified

Novosti u liječenju gestacijskog dijabetesa

Hlača

Majanović

2019

Med. Flum. (Online)

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“…7 Recent data suggest significantly increased rates of overweight and obesity in a cohort of 4-year-old children of mothers with polycystic ovarian syndrome who were exposed to metformin during pregnancy compared to the offspring of non-exposed women. 8 Women of childbearing age with T2DM are now frequently treated with newer oral diabetes therapies such as dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium glucose co-transporter 2 (SGLT-2) inhibitors. In general, preclinical reproduction studies using DPP-4 inhibitors in rats have provided no evidence of impaired fertility or teratogenicity.…”

Section: Introductionmentioning

confidence: 99%

The need for appropriate registration of pregnancy outcomes under newer oral glucose‐lowering therapies

Benhalima

Mathiesen

Paldánius

et al. 2018

Diabetes Obesity Metabolism

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Funding information K. B. is the recipient of a Clinical DoctoralScholarship of the academic fund of UZ Leuven.Because of the increase in type 2 diabetes (T2DM) in young adults, women of childbearing age are frequently treated with newer glucose-lowering therapies, and an increase in unintentional exposure to therapies unapproved for use during pregnancy is expected. The clinician is left with the dilemma of deciding between discontinuation of a novel agent that is providing excellent glycaemic control, while switching to other agents may cause deterioration of glycaemia, and continued use of novel agents that may have uncertain effects on the unborn child. For T2DM, pregnancy data are collected only via spontaneous reporting systems. Therefore, we evaluated the available data on pregnancy outcomes under newer glucose-lowering agents in pharmaceutical safety databases. We found that data on pregnancy outcomes with new glucose-lowering agents in T2DM are scarce, with a high risk of bias towards negative outcomes, limiting their usefulness in robustly assessing safety. Because of the lack of information at present, these agents are not recommended for use during pregnancy or when planning pregnancy. To better guide clinical practice, structured systems of assessing pregnancy outcomes in women receiving these novel agents are urgently needed.antidiabetic drugs, database research, outcomes, pregnancy, safety, type 2 diabetes 1 | INTRODUCTION As type 2 diabetes (T2DM) becomes more prevalent and affects a younger population, the number of women of childbearing age with T2DM will increase. In many countries, the proportion of pregnant women with T2DM has risen to nearly half of all pregnant women with diabetes, with T2DM pregnancies outnumbering type 1 diabetes (T1DM) pregnancies in some metropolitan areas. 1 Women with T2DM are at equally high risk as those with T1DM of adverse pregnancy outcomes such as congenital anomalies and stillbirths. 1 Preconception care, with the aim of optimizing glycaemic control, can reduce adverse pregnancy outcomes. 1 While preconception care for women with T1DM is facilitated through follow-up at diabetes services, women with T2DM often fail to take advantage of this available care.In addition, many pregnancies in women with T2DM are unplanned. 2,3 Because of the potential implications of transplacental passage of oral glucose-lowering agents for the developing fetus, and because of the long-standing experience and efficacy of insulin during pregnancy, insulin is generally recommended as the first-choice treatment during pregnancy to achieve good glycaemic control. 4 Experience with oral hypoglycaemic agents, such as metformin and glibenclamide, during pregnancy mostly concerns women with gestational diabetes. 5,6 In addition, there is a paucity of long-term follow-up data on children exposed to these agents in utero. 7 Recent data suggest significantly increased rates of overweight and obesity in a cohort of 4-year-old children of mothers with polycystic ovarian syndrome who were expose...

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“…10 In addition, metformin use in PCOS pregnancies is associated with a higher risk for the child of being overweight at the age of 4 years. 11 In obese women, metformin had no significant effect on birth weight percentile. 12 A study in 25 children exposed to metformin during the prenatal period reported higher fasting blood glucose and systolic blood pressure, but lower low-density lipoprotein cholesterol than children not exposed to metformin.…”

mentioning

confidence: 97%

“…21 However, the number of reports in which the possible endocrinedisrupting effects of metformin have been studied in humans are very limited, because most, still few, studies have focused on anthropometric measures of the offspring. [9][10][11][12][13] An in vitro study with human testes showed that metformin reduces testosterone production and testicular development. 22 A study from Finland reported no difference in testicular size between boys whose mothers had been treated with metformin during pregnancy and boys whose mothers had been treated with insulin.…”

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confidence: 99%