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Diabet Med. 2017 Jan;34(1):27-36. doi: 10.1111/dme.13150. Epub 2016 Jun 8.

Short- and long-term outcomes of metformin compared with insulin alone in pregnancy: a systematic review and meta-analysis.

Author information

1
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
2
Department of Internal Medicine, St Joseph's Hospital, Comox, British Columbia, Canada.
3
Departments of Pediatrics & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
4
Knowledge Resource Service, Alberta Health Services, Calgary, Alberta, Canada.
5
Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.

Abstract

AIM:

To assess the short- and long-term maternal and fetal impact of metformin in pregnancy compared with insulin.

METHODS:

We performed a comprehensive literature search of MEDLINE, EMBASE, BIOSIS, Cochrane Database of Systematic Reviews and ClinicalTrials.gov. Eligible studies were randomized control trials (RCTs) or follow-up of an RCT that: (1) compared metformin with insulin in pregnancy in women with gestational diabetes mellitus or Type 2 diabetes; and (2) reported maternal or fetal outcomes of interest. Two reviewers extracted the data, evaluated study quality and calculated pooled estimates.

RESULTS:

Sixteen studies (n = 2165 in quantitative analysis) were included. Metformin lowered the risk of neonatal hypoglycaemia [risk ratio (RR) = 0.63; 95% confidence interval (95% CI), 0.45 to 0.87], large for gestational age babies (RR = 0.80; 95% CI, 0.64 to 0.99), pregnancy-induced hypertension (RR = 0.56; 95% CI, 0.37 to 0.85) and total maternal pregnancy weight gain [mean difference (MD) -2.07; 95% CI -2.88 to -1.27]. Metformin did not increase preterm delivery (RR = 1.18; 95% CI 0.67 to 2.07), small for gestational age babies (RR = 1.20; 95% CI, 0.67 to 2.14), perinatal mortality (RR = 0.82; 95% CI, 0.17 to 3.92) or Caesarean section (RR = 0.97; 95% CI, 0.80 to 1.19). Long-term outcome information is limited.

CONCLUSIONS:

Our review found that metformin had no short-term adverse effects on pregnancy, potential benefits in the neonatal period, but limited long-term follow-up information. Prior to routine use, we recommend further follow-up studies of offspring exposed to metformin in utero.

PMID:
27150509
DOI:
10.1111/dme.13150
[Indexed for MEDLINE]

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