Metformin in the management of gestational diabetes

Abstract

Gestational diabetes mellitus (GDM) is a common pregnancy complication detected especially in the second or third trimester of gestation, with an increasing prevalence over recent decades. Pathophysiologically, GDM develops as a consequence of adative metabolic changes, overlapping a previously unknown pancreatic β-cell dysfunction. The major risk factors for GDM include obesity/overweight, advanced maternal age, family history of insulin resistance and/or diabetes, previous history of gestational diabetes and macrosomia, and the presence of polycystic ovary syndrome (PCOS). Many European countries, including Romania, use selective screening (based on risk factors) as a tool for the detection of GDM. As hyperglycemia is associated with a number of severe maternal and fetal complications, the management of patients with GDM involves a multidisciplinary team consisting of obstetricians, maternal-fetal medicine specialists and diabetes specialists with experience in treating pregnant women. Insulin is the first-choice treatment if lifestyle optimization methods fail. In recent years, attention has focused on oral antidiabetics, specifically on the efficacy and safety of their use as an alternative to insulin treatment. Metformin is an oral antidiabetic of the biguanide class, the first-line treatment for type 2 diabetes outside pregnancy. Due to reduced maternal complications, low cost and increased compliance, the use of metformin in the treatment of GDM is increasing. Most trials have not reported an increased rate of maternal complications in patients treated with metformin. Short-term fetal effects are favorable, but for long-term effects, the results are still unclear. Most medical societies consider metformin safe and effective, but due to a lack of data on the long-term safety profile, it is only recommended for use in cases where insulin therapy is not an option.