- A new study indicates that the medication metformin may benefit people with gestational diabetes.
- Metformin is a drug typically used to help treat Type 2 diabetes but is not widely used for gestational diabetes because it crosses the placenta.
- Metformin’s effects on secondary outcomes showed some benefits and some inconsistencies, paving the way for further investigation into these relationships.
New research investigated if there are new methods to help pregnant women manage gestational diabetes mellitus. A new study from the University of Galway, published October 3 in JAMA: the Journal of American Medical Association, indicates that the medication metformin may offer some benefits to women with gestational diabetes.
“This is a really interesting study because there have not been a lot of randomized controlled trials with placebos looking at the management of gestational diabetes,” said Dr. Meghana Limaye, maternal-fetal medicine specialist and clinical assistant professor in the Department of Obstetrics & Gynecology at NYU Langone Health.
Metformin is a drug typically used to help treat type 2 diabetes but is not widely used for gestational diabetes because it crosses the placenta. The new results show that metformin, which is administered via a pill, may be safely used to treat gestational diabetes and reduce the likelihood of needing injection-administered insulin shots. However, the researchers noted that the study was not designed to definitively confirm the safety of metformin regarding specific outcomes.
“Metformin has been used for many years already with diabetes. It has been used for many years in gestational diabetes. But there were always questions about whether it is safe or not, or whether or not we should move right away to insulin,” said Dr. Eran Bornstein, Vice Chair of OB/GYN at Northwell Lenox Hill Hospital. “This study is very reassuring because it shows women took Metformin and had some benefits. It looks like it gives you a first glimpse that metformin may be associated with several improved outcomes.”
What is gestational diabetes?
Gestational diabetes is a condition that affects nearly three million women around the world each year. It’s a type of diabetes that can develop during pregnancy in women who do not already have diabetes. According to the Centers for Disease Control and Prevention, each year 2 to 10% of pregnancies in the U.S. are affected by gestational diabetes.
It occurs when the body cannot make enough insulin during the pregnancy. Insulin is important for transferring blood sugar to the cells to be used as energy.
“Any woman is at risk for gestational diabetes,” said Limaye. “But some risk factors include being overweight, having a history of diabetes in the family, or having had gestational diabetes before.”
She added, “The main things associated with gestational diabetes are related to the fetus growing too large. It can be associated with birth complications, like increasing the rates of a C-section, hemorrhaging after delivery, or shoulder dystocia.”
The CDC notes other related health problems for the baby, including:
- Being born early, which can cause breathing and other problems
- Having low blood sugar
- Developing type 2 diabetes later in life
There are no symptoms for gestational diabetes. Pregnant women will have to be tested in order to be diagnosed.
How is gestational diabetes traditionally treated?
Fortunately, gestational diabetes is a condition that can be managed. Many women are able to reverse their gestational diabetes based on lifestyle.
“We have pregnant women check their sugars four times a day, which is pretty intensive,” said Limaye. “They are able to monitor their food intake of sugary drinks, increase protein, and decrease carbohydrate intake to manage their diet alone. If sugars continue to be elevated, in order to decrease the risk of complications, we would recommend insulin.”
Metformin vs. insulin for gestational diabetes
When it comes to medication treatments for gestational diabetes, insulin is often the go-to. The American Diabetes Association says that insulin is the traditional first-choice drug for blood glucose control during pregnancy because it is the most effective for fine-tuning blood glucose. It also does not cross the placenta, which means it is completely safe for the baby.
“I like to use insulin for several reasons,” said Bornstein. “It’s safe, it’s safe for the baby, and it has years of experience with a good safety profile. It’s easy to titrate, as well. With a pill, you’re limited to the multiplication of the milligrams of a pill. With insulin, you can really titrate it.”
However, insulin is administered through injection and so many patients would prefer to avoid insulin because they want to avoid having to inject themselves sometimes multiple times per day.
The study from the University of Galway was a randomized, placebo-controlled trial that involved more than 500 pregnant women. It found that women assigned to metformin were 25% less likely to need insulin, and in the cases when insulin was necessary, it was started later in the pregnancy.
The study also found that women receiving metformin gained less weight throughout the trial and maintained this weight differently at the 12-week post-delivery visit. Delivery also occurred at the same mean gestational age in both groups, and there was no evidence of any increase in preterm birth among those who received metformin.
The study also showed no differences in adverse neonatal outcomes, including the need for intensive care treatment for newborns, respiratory support, jaundice, congenital anomalies, birth injuries, or low sugar levels.
However, the study also showed that nearly 40% of women who were given metformin also needed to start insulin later in their pregnancy in order to better regulate glucose levels. So for many patients who may take metformin, insulin may still be part of the prescribed regimen during their pregnancy.
The study is a positive first step, but experts are still waiting to see more studies in the future.
This study was a little bit small to look at the impact on the babies and what the long-term effect will be,” said Limaye. “The authors will be following the children and mothers to see what they do in the longer term. You need more babies exposed to metformin in order to evaluate.”
“The take-home message is it’s important to perform screening for gestational diabetes in every pregnancy,” said Bornstein. “It’s important to individualize care with a specialized doctor. Some women may do well with dietary medication and exercise and some may require assistance. For those who require assistance, starting metformin is a reasonable option.”
Takeaway
A new study investigated whether metformin could help pregnant people with gestational diabetes.
The study found that women receiving metformin gained less weight throughout the trial and maintained this weight differently at the 12-week post-delivery visit. Delivery also occurred at the same mean gestational age in both groups, and there was no evidence of any increase in preterm birth among those who received metformin.
Gestational Diabetes, Study Finds Metformin May Help
Source: Pinoy Lang Sakalam
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