To read the full abstract: JAMA Pediatr 2019;173:160168
This paper describes a large population-based cohort of women in New Zealand who received metformin (n=1996 women) or insulin (n=1932) for treatment of gestational diabetes mellitus (GDM). There were no differences between the two groups in any measure of offspring childhood height, weight for height, or behavioural development.
There have been substantial changes in the detection and management of GDM in recent years. Implementation of the 2010 International Association of the Diabetes and Pregnancy Study Group (IADPSG) criteria has led to the diagnosis of many more women as having GDM, possibly up to 611 times more, compared to previous criteria (1). This has created a major challenge how to best manage this condition which affects an estimated 10% of all pregnancies worldwide. A large proportion of GDM women receive only lifestyle advice combined with glucose monitoring. Subcutaneous insulin therapy is a far more intensive option. It seems sensible that, somewhere between those two options, oral anti-hyperglycaemic agents, such as Metformin, should have an important role. While Metformin is being used increasingly for GDM in many countries, in several settings it is little used, possibly due to concerns about possible risks of birth defects and other pregnancy complications its mechanism of action is not fully understood and there are concerns from in vitro studies that Metformin impairs mitochondrial function, by inhibiting Complex I of the respiratory chain. In this light, the findings of the current large study are highly reassuring.
Reference: 1. Behboudi-Gandevani S, Amiri M, Bidhendi Yarandi R, Ramezani Tehrani F. The impact of diagnostic criteria for gestational diabetes on its prevalence: a systematic review and meta-analysis. Diabetol Metab Syndr. 2019 Feb 1;11:11.