The emerging role of metformin in gestational diabetes mellitus

Abstract

Metformin use during pregnancy is controversial and there is disparity in the acceptance of metformin treatment in women with gestational diabetes mellitus (GDM) in Australia. Despite short term maternal and neonatal safety measures, the placental transfer of metformin during GDM treatment and the absence of long-term safety data in offspring has regulators and prescribers cautious about its use. To determine the current role in GDM management, this literature review describes the physiological changes that occur in GDM and other forms of diabetes in pregnancy (DIP) and international changes in guidelines for GDM diagnosis. Management options are considered, with a focus on the evolving evidence for metformin, its mechanism of action, the maternal, foetal and neonatal outcomes associated with its use and benefit vs risk when compared with the current gold standard, insulin. Investigation reveals a favourable balance of evidence to support the safety and long-term benefits, to mother and child, of using metformin as an alternate to insulin for treatment of GDM. Recent findings of the gastrointestinal-directed action of metformin are at least as important as the hepatic effect and the availability of a novel delayed-release metformin dose form to exploit this new information provides a product and therapeutic strategy ideally suited to the use of metformin in GDM.

Metformin, the aspirin of the 21st century: its role in gestational diabetes mellitus, prevention of preeclampsia and cancer, and the promotion of longevity

“…Similar concentrations of metformin in the umbilical artery and umbilical vein suggest negligible metformin metabolism by the fetus (244). Several meta-analyses that studied the teratogenic effect of metformin on embryonic development found that this drug carries no increased risk for congenital malformations(245, 246) and is currently classified as category B in the United States and as category C in Australia (247, 248). Similarly, no excess of fetal or neonatal complications could be demonstrated when the administration of metformin was compared to glyburide and insulin(249).…”

Multidimensional effects of metformin in patients with type 2 diabetes

“…(2017), принимая во внима-ние краткосрочные данные о материнской и неонаталь-ной безопасности, отмечают, что плацентарный перенос метформина и отсутствие долгосрочных результатов по безопасности у потомства обосновывают осторож-ность в использовании препарата при беременности [73]. Авторы соглашаются с благоприятным балансом дока-зательств, подтверждающих преимущества безопасно-сти использования метформина для матери и ребенка при ГСД.…”

Glukosestoffwechsel und assistierte Reproduktion

“…Risiken sind weder für die Mütter noch für die ungebore-nen Kinder bekannt. Zahlreiche Länder weltweit setzen bereits Metformin anstelle von Insulin zur medikamentösen Therapie des GDM ein [14].…”