Metformin in gestational diabetes mellitus
Abstract
Gestational diabetes mellitus (GDM) can affect up to 1 in 5 of pregnancies and is associated with adverse pregnancy outcomes including pre-eclampsia, neonatal hypoglycaemia, large for gestational age, increased adiposity and birth trauma. Good glycaemic control is the key to reduce these outcomes. Diet and lifestyle modification followed by insulin as necessary is the conventional type of management. Metformin is increasingly used in pregancy but with limited evidence, its role in GDM has not been well-established. \n \nA systematic review including both randomized and non-randomized controlled studies have been conducted to evaluate the contemporary evidence of metformin in GDM. It is suggested that metformin in GDM could be a useful alternative to insulin and is regarded as the best oral anti-hyperglycaemic agent in GDM management currently. However, almost half of metformin-treated GDM patients required supplementary insulin to achieve target glucose levels (metformin failure). Women with higher metabolic risk factors are likely to develop metformin failure. \n \nA clinical cohort of metformin-treated GDM is used to develop the predictive model to identify GDM women who are at risk of metformin failure. It has been found that women identified by new IADPSG and NICE 2015 fasting criteria are highly likely to develop metformin failure. It has also been established a number of algorithm based on various baseline characters of GDM women which will help primary healthcare…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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