Metformin in Pregnancy: Mechanisms and Clinical Applications

Steve Hyer, Jyoti Balani, Hassan Shehata, Steve Hyer, Jyoti Balani, Hassan Shehata

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.

Keywords: gestational diabetes; metformin; obesity; polycystic ovarian syndrome; pregnancy; type 2 diabetes.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Baseline characteristics of the subset of 118 women randomised to metformin and placebo groups.
Figure 2
Figure 2
Changes in fasting insulin, HOMA-IR, and C-reactive protein from baseline to 28 weeks gestation. (A): Change in fasting insulin between the metformin and placebo groups: ** p: 0.009. (B): Change in HOMA IR between the metformin and placebo groups: * p: 0.03. (C): Change in C-reactive protein between the metformin and placebo groups: p: NS.
Figure 3
Figure 3
Changes in maternal visceral fat mass at entry (A), 28 weeks (B), term (C) and after pregnancy (D) (** p = 0.01).
Figure 4
Figure 4
Pregnancy outcomes in women randomised to the metformin and placebo groups.
Figure 5
Figure 5
Neonatal outcomes in women randomised to the metformin and placebo groups.

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