No adverse outcomes with metformin in women with GDM
Use of metformin during the first trimester of pregnancy showed no significant maternal or foetal adverse outcomes in women with gestational diabetes mellitus (GDM), according to a study presented at IDF 2017.
The researchers retrospectively analysed 540 pregnant women (mean age 29 years). Participants were divided into three groups according to the prescribed medications: group A (n=186; metformin in the first trimester), group B (n=203; metformin after the first trimester), and group C (n=151; insulin in any trimester). Patients were diagnosed with GDM at a mean gestational age of 10, 23, and 24 weeks in groups A, B, and C, respectively. The study’s primary outcome was a composite of neonatal hypoglycaemia, respiratory distress, need for phototherapy, birth trauma, 5-minute APGAR score <7, and prematurity. [IDF 2017, abstract P-0972]
Results of the primary composite outcomes did not differ significantly between groups A and B (odds ratio [OR], 1.738, 95 percent confidence interval [CI], 0.657–4.597) and groups A and C (OR, 1.717, 95 percent CI, 0.715–4.119).
Of the 184 participants on metformin, 53.22 and 41.87 percent required supplemental insulin in groups A and B, respectively.
However, a higher rate of preterm births was observed among patients in group A compared with groups B and C (9.67 percent vs 6.89 percent and 9.27 percent, respectively) as well as a higher rate of pregnancy loss (11 vs 1 and 2, respectively).
These findings were consistent with a previous study which showed higher rates of preterm birth among patients on metformin compared with insulin (12.1 percent vs 7.6 percent). [N Engl J Med 2008;358:2003-2015]
“Prematurity and foetal loss are two outcomes that warrant further critical evaluation in future studies in larger cohorts of GDM,” said lead author Dr Riddhi Das Gupta from the Department of Endocrinology, Diabetes & Metabolism at Christian Medical College in Vellore, India.“[Nonetheless,] our findings strongly suggest that metformin … can prove to be a safe, effective, and cheaper modality of treatment in the first trimester of gestation in GDM mothers,” Das Gupta noted.