Metformin should be considered in the treatment of gestational diabetes: a prospective randomised study
Abstract
OBJECTIVE: To examine if oral metformin is as effective as insulin in the prevention of fetal macrosomy in pregnancies complicated with gestational diabetes mellitus (GDM).
DESIGN: Open-label prospective randomised controlled study.
SETTING: Maternity outpatient clinics in a secondary and tertiary level hospital in Finland.
SAMPLE: One hundred women with GDM who did not attain euglycaemia with diet.
METHODS: Women were randomised to therapy with insulin (n = 50) or oral metformin (n = 50).
MAIN OUTCOME MEASURES: Incidence of large-for-gestational-age (LGA) infants and neonatal morbidity.
RESULTS: There were no statistically significant differences in the incidence of LGA (8.5 versus 10.0%, P = 0.97), mean birthweight, mean cord artery pH or neonatal morbidity between the insulin and metformin groups. Fifteen (31.9%) of the 47 women randomised to metformin needed supplemental insulin. They were more obese (with a body mass index of 36 versus 30 kg/m(2), P = 0.002), had higher fasting blood glucose levels in an oral glucose tolerance test (6.1 versus 5.0 mmol/l, P = 0.001) and needed medical treatment for GDM earlier (26 versus 31 gestational weeks, P = 0.002) than women who were normoglycemic with metformin. There was a tendency to a higher rate of caesarean sections in the metformin group than in the insulin group (RR 1.9; 95% CI 0.99-3.71).
CONCLUSIONS: Metformin seems to be suitable for the prevention of fetal macrosomy, especially in lean or moderately overweight women…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 50 participants or records.
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