- This meta-analysis suggests that metformin therapy for gestational diabetes mellitus (GDM) may have potential benefits with no increased risk for adverse maternal and neonatal outcomes compared with insulin.
Why this matters
- Findings provide support for the regular use of metformin as a treatment strategy that can improve the management of GDM.
- 24 studies (17 randomised controlled trials for quantitative analyses: n=2828; 7 studies for qualitative synthesis) met eligibility criteria after a search on PubMed, Embase and the Cochrane database.
- Funding: None disclosed.
- Metformin vs insulin therapy for GDM was associated with a reduced risk for:
- pregnancy-induced hypertension (risk ratio [RR], 0.64; 95% CI, 0.44-0.95; P=.03);
- large gestational age babies (RR, 0.82; 95% CI, 0.68-0.99; P=.04);
- macrosomia (RR, 0.63; 95% CI, 0.45-0.90; P=.01);
- neonatal hypoglycaemia (RR, 0.72, 95% CI, 0.59-0.88; P=.001); and
- neonatal intensive care unit admission (RR, 0.74; 95% CI, 0.58-0.94; P=.01).
- Metformin use did not increase the risk for:
- premature delivery (RR, 1.28; 95% CI, 0.95-1.73; P=.11);
- pre-eclampsia (RR, 0.89; 95% CI, 0.65-1.21; P=.45);
- caesarean delivery (RR, 0.94; 95% CI, 0.85-1.04; P=.20); and
- small for gestational age babies (RR, 0.99; 95% CI, 0.69-1.42; P=.95).
- Lack of uniformity for GDM.