Abstract
Objective
The aim of the study was to compare maternal and neonatal outcomes in women with gestational
diabetes mellitus (GDM) treated with metformin in addition to the dietary and lifestyle
advice versus those treated traditionally with dietary and lifestyle advice only.
Study design
A retrospective study of singleton pregnancies in women with GDM delivered between
January 2008 to June 2010 (n = 592) at the Jessop Wing, Royal Hallamshre Hospital, UK. Introduction of metformin
in August 2008 led to two comparable groups, those women receiving metformin, lifestyle
advice (including dietary advice) ± supplementary insulin and those women receiving lifestyle advice (including dietary
advice) ± supplementary insulin. Two hundred and ninety three women were treated with metformin
and lifestyle advice and remaining 299 with lifestyle advice only. Supplementary insulin
was used in both the groups if needed. Outcomes were analyzed using the chi-squared
and t-tests.
Results
There were no significant differences in baseline maternal characteristics between
the two groups. Metformin was tolerated throughout the pregnancy by 90% of the women
in the metformin + lifestyle advice group. Supplementary insulin was required by 21% in the metformin + lifestyle advice group compared to 37% in the lifestyle advice group (OR 0.46; 95%
CI 0.32–0.66). Women in the metformin group had a significantly lower incidence of
macrosomia (birth weight > 4 kg) (8.2% vs. 14.3% (OR 0.56; 95% CI 0.33–0.99)), as well as birth weight >90th centile
(14.8% vs. 23.7% (OR 0.56; 95% CI 0.37–0.85)). There were no significant differences
in maternal outcome measures between the groups. No serious maternal or neonatal adverse
events were observed with the use of metformin.
Conclusion
Metformin is safe and effective in the treatment of GDM in our experience. It is well
tolerated and reduces the requirement for supplementary insulin. Women treated with
metformin had a significantly lower incidence of macrosomic and large for gestational
age neonates as well as a reduced caesarean section rate.
Keywords
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Article info
Publication history
Published online: November 24, 2011
Accepted:
November 8,
2011
Received in revised form:
September 27,
2011
Received:
August 9,
2011
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
