FRI632 Metformin Use In Gdm Is Not Associated With Increased Incidence Of Preterm Labor And Small For Gestational Age Infants Compared To Diet Control Alone

Abstract

Abstract Disclosure: A. D'Souza: None. F. Badri: None. H. Abdullahi: None. I. Ibrahim: None. Gestational diabetes mellitus (GDM), the most frequent medical complication of pregnancy, is becoming a growing public health issue with its national prevalence of 21.5% greater than the estimated global prevalence of 17%.1,2 Among those who required treatment for GDM in Qatar, 91.8% were on metformin either alone or in combination with insulin.1 Given the limited data on the effects of metformin exposure in pregnancy, the study aimed to investigate the association between the use of metformin in GDM and the incidence of various maternal and neonatal outcomes. It was hypothesized that metformin use in GDM is not associated with increased incidence of adverse maternal and neonatal outcomes in this high-risk population. This retrospective cohort study looked at women with GDM who sought prenatal care at Sidra Medicine, Doha, Qatar between January 2019 and December 2020 and compared the incidence of various maternal and neonatal outcomes in patients on metformin to those on diet control alone. 649 women with GDM were included in the study; of which 438 were on diet control alone and 211 were on metformin. Women in the metformin group were older and heavier at baseline and gained lesser weight during pregnancy (p<.001). Subjects in the metformin-treated arm had a significantly lower gestational age at delivery (37.8 vs. 38.6 weeks, p<.001), higher incidence of C-section (50.7 vs. 42.2%, p=.042), and higher incidence of polyhydramnios (6.6 vs. 2.1%, p=.003) compared to those in the diet-controlled group. The mean birth weight percentile (66.5 vs. 59.9, p=.008), incidence of large for gestational age (LGA) infants (27 vs. 18%, p=.008) and incidence of neonatal jaundice (1.9 vs. 0.2%, p=.041) in the metformin-treated group were higher, but there was no significant difference in the incidence of other neonatal outcomes between the two groups. In particular, metformin was not associated with increased incidence of preterm labor and small for gestational age (SGA) infants in pregnancy as suggested by previous studies. However, women on metformin had a higher incidence of C-section, polyhydramnios, LGA infants, and neonatal jaundice, and increased mean neonatal weight percentile at birth compared to diet control alone. This could be attributed to the higher degree of maternal hyperglycemia and increased severity of disease in the patients on metformin. In conclusion, our study showed that the use of metformin in GDM is not associated with the increased incidence of preterm labor and SGA infants.