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Metformin treatment for gestational diabetes

Department of Diabetes & Endocrinology, St Helier Hospital, Carshalton, Surrey, UK

Jyoti Balani

Department of Diabetes & Endocrinology, St Helier Hospital, Carshalton, Surrey, UK

Antoinette Johnson

Department of Maternal Medicine, Epsom & St Helier Hospital University Hospitals NHS Trust, Carshalton, Surrey, UK

Hassan Shehata

Department of Maternal Medicine, Epsom & St Helier Hospital University Hospitals NHS Trust, Carshalton, Surrey, UK, hassan.shehata{at}nhs.net

The prevalence of gestational diabetes mellitus (GDM) is rising as the pregnant population becomes older and more obese. This is concerning because GDM is associated with increased perinatal morbidity such as macrosomia and shoulder dystocia, and the need for instrumental delivery. In addition, the offspring of GDM women have increased long-term risks of obesity and type 2 diabetes. There is no doubt that treating women with GDM improves pregnancy outcomes. Conventionally this has been by diet and insulin. Although effective, insulin increases appetite leading to weight gain. It increases the risk of hypoglycaemia and needs to be given by injection. There is also a substantial cost in terms of time for teaching and educating patients. Metformin offers a logical alternative to insulin in GDM, by reducing insulin resistance. Recent trial evidence indicates it is safe and effective. We describe our experience with metformin in GDM and review the evidence.

Key Words: gestational diabetes • macrosomia • metformin

References

• Reece EA, Homko CJ Pregnancy outcomes in gestations complicated by type 2 diabetes. Curr Diab Rep 2005;5:269-71.[CrossRef][Medline] [Order article via Infotrieve]
• Farrell T., Neale L., Cundy T. Congenital anomalies in the offspring of women with type 1, type 2 and gestational diabetes. Diabet Med 2002;19:322-6.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Boney CM, Verma A., Tucker R., Vohr BR Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Paediatrics 2005;115:e290-6.[Abstract/Free Full Text]
• Hyer SL, Shehata HA Gestational diabetes mellitus. Curr Obstet Gynaecol 2005;15:368-74.[CrossRef]
• Fraser R., Heller SR Gestational diabetes: aetiology and management. Obstet Gynaecol Reprod Med 2007;17:345-8.[CrossRef]
• Crowther CA, Hiller JE, Moss JR et al. The Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;352:2477-88.[Abstract/Free Full Text]
• de Veciana M., Major CA, Morgan MA et al. Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. N Engl J Med 1995;333: 1237-41.[Abstract/Free Full Text]
• Weisz B., Shrim A., Homko CJ et al. One hour versus two hours postprandial glucose measurement in gestational diabetes: a prospective study. J Perinatol 2005;25:241-4.[CrossRef][Medline] [Order article via Infotrieve]
• Mathieson ER, Kinsley B., Amiel SA et al. On behalf of the Insulin Aspart Pregnancy Study Group. Maternal glycaemic control and hypoglycaemia in type 1 diabetic pregnancy. Diabetes Care 2007;30:771-6.[Abstract/Free Full Text]
• US Food and Drug Administration website: http://www.accessdata,fda,gov/drugsatfda_docs/label/2008/020357s031,021202s016lbl.pdf (Accessed 7th September 2009).
• Duncan C. Highlights from the Fifth International Symposium on Diabetes and Pregnancy. Br J Diabetes Vasc Dis 2009;9:139-40.[Free Full Text]
• Glueck CJ, Goldenberg N., Wang P. et al. Metformin during pregnancy reduces insulin, insulin resistance, insulin secretion, weight, testosterone and development of gestational diabetes: prospective longitudinal assessment of women with polycystic ovary syndrome from preconception throughout pregnancy. Hum Reprod 2004; 19:510-21.[Abstract/Free Full Text]
• Hawthorne G. Metformin use and diabetic pregnancy-has its time come? Diab Med 2006;23:223-7.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Brown FM, Wyckoff J., Rowan JA et al. Metformin in pregnancy: Its time has not yet come. Diabetes Care 2006;29:485-6.[Free Full Text]
• Hughes RCE, Rowan JA Pregnancy in women with Type 2 diabetes: who takes metformin and what is the outcome? Diabet Med 2006;23:318-6.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Glueck CJ, Wang P., Goldenberg N., Seive-Smith L. Pregnancy outcomes among women with polycystic ovary syndrome treated with metformin. Hum Reprod 2002;17:2858-64.[Abstract/Free Full Text]
• Jakubowicz DJ, Iuorno MJ, Jakubowicz S. Effects of metformin on early pregnancy loss in the polycystic ovary syndrome. J Clin Endocrinol Metab 2002;87:524-9.[Abstract/Free Full Text]
• Glueck CJ, Bornovali S., Pranikoff J. et al. Metformin, pre-eclampsia, and pregnancy outcomes in women with polycystic ovary syndrome. Diabet Med 2004;21:829-36.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Glueck CJ, Goldenberg N., Pranikoff J. et al. Height, weight, and motor-social development during the first 18 months of life in 126 infants born to 109 mothers with polycystic ovary syndrome who conceived on and continued metformin through pregnancy. Hum Reprod 2004;19:1323-30.[Abstract/Free Full Text]
• Rowan JA, Hague WM, Gao W. et al. For the MiG Trial Investigators. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med 2008;358:2003-15.[Abstract/Free Full Text]
• Hughes RCE, Gardiner SJ, Begg EJ, Zhang M. Effect of pregnancy on the pharmacokinetics of metformin. Diabet Med 2006;23:323-6.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Glueck CJ, Salehi M., Sieve L., Wang P. Growth, motor, and social development in breast and formula-fed infants of metformin-treated women with polycystic ovary syndrome. J Pediatr 2006;148:628-32.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Balani J., Hyer SL, Rodin DA, Shehata H. Pregnancy outcomes in metformin-treated women with gestational diabetes. Diabetologia 2008;51(Suppl 1):S1-S588, 1147.
• Balani J., Hyer SL, Rodin DA, Shehata H. Pregnancy outcomes in women with gestational diabetes treated with metformin or insulin: a case control study. Diabet Med 2009;26:798-802.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Gardosi J., Francis A. Customised Centile Calculator: GROW-Centile v 5.1. Gestation Network, www.gestation.net. Birmingham: Perinatal Institute, 2006.
• National Institute for Health and Clinical Excellence Diabetes in pregnancy: full guideline. London: NICE, 2008.

The British Journal of Diabetes & Vascular Disease, Vol. 9, No. 5, 220-225 (2009)
DOI: 10.1177/1474651409346767


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This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Scopus Google Scholar Articles by Hyer, S. L Articles by Shehata, H. Social Bookmarking                         What's this?