Abstract
Metformin is increasingly being used a therapeutic option for the management of gestational diabetes mellitus (GDM). The aim of this study was to compare the maternal characteristics and perinatal outcomes of women with GDM treated with metformin (with or without supplemental insulin) with those receiving other management approaches. A retrospective, case-control study was carried out and 83 women taking metformin were matched 1:1 with women receiving insulin or diet and lifestyle modification alone. Women managed with diet and lifestyle modification had a significantly lower fasting plasma glucose (p < 0.001) and HbA1c (p < 0.01) at diagnosis of GDM. Furthermore, women managed with metformin had a higher early pregnancy body mass index (BMI) compared to those receiving insulin or diet and lifestyle modification (p < 0.001). There was no difference in mode of delivery, birth weight or incidence of large- or small-for-gestational-age neonates between groups. Women receiving glucose lowering therapies had a higher rate of neonatal hypoglycaemia (p < 0.05). The incidence of other adverse perinatal outcomes was similar between groups. Despite their greater BMI, women with metformin-treated GDM did not have an increased risk of adverse perinatal outcomes. Metformin is a useful alternative to insulin in the management of GDM.
Highlights
The incidence of gestational diabetes mellitus (GDM) is increasing in Australia and worldwide [1].The latest diagnostic criteria recommended by the International Association of Diabetes and PregnancyStudy Groups (IADPSG) and endorsed by the Australasian Diabetes in Pregnancy Society (ADIPS)are more stringent than previous criteria and have led to an increase in the prevalence of GDM [2].Following diagnosis, women with GDM routinely receive dietary education and lifestyle advice; with pharmacological therapy initiated if target blood glucose levels are not attained [3]
There was no difference in the incidence of shoulder dystocia, respiratory distress, jaundice, neonatal intensive care unit (NICU) admission, birth injury, birth defect or neonatal death in women treated with metformin compared to those managed with insulin or diet and lifestyle modification
The results of the present analysis demonstrate that treatment of women with GDM with metformin gives rise to similar perinatal outcomes in comparison to women managed with insulin alone or diet and lifestyle modification alone
Summary
The incidence of gestational diabetes mellitus (GDM) is increasing in Australia and worldwide [1].The latest diagnostic criteria recommended by the International Association of Diabetes and PregnancyStudy Groups (IADPSG) and endorsed by the Australasian Diabetes in Pregnancy Society (ADIPS)are more stringent than previous criteria and have led to an increase in the prevalence of GDM [2].Following diagnosis, women with GDM routinely receive dietary education and lifestyle advice; with pharmacological therapy initiated if target blood glucose levels are not attained [3]. The incidence of gestational diabetes mellitus (GDM) is increasing in Australia and worldwide [1]. The latest diagnostic criteria recommended by the International Association of Diabetes and Pregnancy. Study Groups (IADPSG) and endorsed by the Australasian Diabetes in Pregnancy Society (ADIPS). Are more stringent than previous criteria and have led to an increase in the prevalence of GDM [2]. Treatment of GDM has been shown to significantly improve perinatal outcomes, with reductions in macrosomia, birth injury and neonatal death [4,5]. A number of studies have demonstrated that treatment of GDM with metformin can lead to adequate glycaemic control and does not increase the risk of adverse perinatal outcomes [6,7].
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