Early Metformin May Not Aid Gestational Diabetes

THURSDAY, Oct. 5, 2023 (HealthDay News) -- Early metformin initiation in women with gestational diabetes does not reduce the occurrence of the combination of a fasting glucose level ≥5.1 mmol/L at gestation weeks 32 or 38 or insulin initiation, according to a study published online Oct. 3 in the Journal of the American Medical Association to coincide with the European Association for the Study of Diabetes Annual Meeting 2023, held from Oct. 2 to 6 in Hamburg, Germany.

Fidelma Dunne, Ph.D., from the University of Galway in Ireland, and colleagues assessed whether early initiation of metformin reduces insulin initiation or improves fasting hyperglycemia at gestation weeks 32 or 38. The analysis included 510 participants (535 pregnancies) randomly assigned to metformin or placebo.

The researchers found that the primary composite outcome of insulin initiation or a fasting glucose level ≥5.1 mmol/L was not significantly different between groups (56.8 percent in the metformin group versus 63.7 percent in the placebo group; between-group difference, −6.9 percent). For the prespecified secondary maternal outcomes, time to insulin initiation, self-reported capillary glycemic control, and gestational weight gain favored the metformin group. For secondary neonatal outcomes, smaller neonates (lower mean birth weights, a lower proportion weighing >4 kg, a lower proportion in the >90 percent percentile, and smaller crown-heel length) were seen in the metformin group. There were no differences observed between the groups for neonatal intensive care needs, respiratory distress requiring respiratory support, jaundice requiring phototherapy, major congenital anomalies, neonatal hypoglycemia, or proportion with five-minute Apgar scores <7.

"Ongoing review of rates of small for gestational age should continue when using metformin," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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