Abstract
Metformin use in pregnancy is increasing worldwide as randomised controlled trial (RCT) evidence is emerging demonstrating its safety and efficacy. The Metformin in Gestational Diabetes (MiG) RCT changed practice in many countries demonstrating that metformin had similar pregnancy outcomes to insulin therapy with less maternal weight gain and a high degree of patient acceptability. A multicentre RCT is currently assessing the addition of metformin to insulin in pregnant women with type 2 diabetes. RCT evidence is also available for the use of metformin in pregnancy for women with Polycystic Ovarian Syndrome and for nondiabetic women with obesity. No evidence of an increase in congenital malformations or miscarriages has been observed even when metformin is started before pregnancy and continued to term. Body composition and metabolic outcomes at two, seven, and nine years have now been reported for the offspring of mothers treated in the MiG study. In this review, we will briefly discuss the action of metformin and then consider the evidence from the key clinical trials.
Highlights
In recent years, metformin has gained acceptance as a safe, effective and rational option for reducing insulin resistance in pregnant women with type 2 diabetes, gestational diabetes (GDM) or polycystic ovarian syndrome (PCOS)
Diabetes Canada states that metformin may be used as an alternative to insulin adding that women should be informed that metformin crosses the placenta, longer term studies are not yet available and the addition of insulin is necessary in approximately 40% to achieve adequate glycaemic control [3]
We will briefly consider the action of metformin and review the major clinical trials of metformin use in pregnancy including its use in obese non-diabetic women and as an addition to insulin in type 2 diabetes
Summary
Reducing the Risk of Developing Diabetes CONTENTS (Continued): April 2018 Volume 42 Supplement 1 Hyperglycemic Emergencies in Adults Weight Management in Diabetes Macrovascular and Microvascular Complications. Investigators, M.T. Metformin versus insulin for the treatment of gestational diabetes. Pregnancy outcomes in women with gestational diabetes treated with metformin or insulin: A case-control study. Pregnancy outcomes after metformin treatment for gestational diabetes: A case-control study. Metformin vs insulin in the management of gestational diabetes: A meta-analysis. R.C.E.; Rowan, J.A. Pregnancy in women with Type 2 diabetes: Who takes metformin and what is the outcome? S.; Mohsen, I.A.; Aboul Foutouh, I.; Ashmawi, H.S.; Mohsen, M.N.; van Wely, M.; van der Veen, F.; Youssef, M.A. Can metformin reduce the incidence of gestational diabetes mellitus in pregnant women with polycystic ovary syndrome? J.A.; Rush, E.C.; Plank, L.D.; Lu, J.; Obolonkin, V.; Coat, S.; Hague, W.M. Metformin in gestational diabetes: The offspring follow-up (MiG TOFU): Body composition and metabolic outcomes at 7–9 years of age. Metformin therapy during pregnancy: Good for the goose and good for the gosling too? Diabetes Care 2011, 34, 2329–2330. [CrossRef] [PubMed]
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