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Metformin as treatment of GDM
Örebro University, School of Medical Sciences.ORCID iD: 0000-0001-7616-3306
Örebro University, School of Medical Sciences. Örebro University Hospital.ORCID iD: 0000-0002-3707-6696
Örebro University, School of Medical Sciences.
Örebro University, School of Medical Sciences. 3School of Medicine, Western Sydney University, Campbelltown, Australia.
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2023 (English)Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Background: Whether metformin should be used as treatment for gestational diabetes mellitus (GDM) is a matter of controversy. Concerns about the effects on neonatal birth weight (mainly small for gestational age, SGA) have been raised in one randomized controlled trial in type 2 diabetes in pregnancy. [1] The aim of this study was to evaluate pregnancy outcomes based on different GDM treatment modalities with focus on metformin.

Methods: A cohort study, based on data from the stepped wedge cluster randomized trial; CDC4G (Changing diagnostic criteria for GDM in Sweden - www.cdc4g.se). Screening for GDM involved repeated random plasma glucose measurements and/or clinical risk factors. [2] Data were collected from electronic case record forms, and national health and quality registers. Singleton pregnancies during 2018 (last birth in August 2019) from eight clusters were included. Women with pregestational diabetes and/or previous gastric bypass surgery were excluded. Pregnancy outcomes for different treatment regimens were analyzed for women with GDM compared to the background population without GDM. Logistic regression analyzes with adjustments for confounders (body mass index, age, smoking, country of birth, chronic hypertensive disease and cluster) was performed (adjusted odds ratio (aOR) with 95% confidence interval (CI)) for all outcomes. 

Results: Of the 54 678 pregnancies included, 2 169 (4.0%) were diagnosed with GDM; of whom 1 076 (49.6%) were treated with diet only (dGDM), 668 (30.8%) with metformin only (mGDM), 116 (5.3%) with insulin only (iGDM), and 309 (14.2%) with both metformin and insulin (miGDM). Pregnancy outcomes were as follows: SGA (10th percentile) was significantly decreased in the mGDM group [aOR 0.57 (95% CI 0.41-0.79)] compared to the background population and no significant difference was found in the miGDM group [aOR 0.78 (95% CI 0.51-1.18)] compared to the background population. No significant difference in SGA (10th percentile) was found in the dGDM group [aOR 1.02 (CI 0.83-1.25)] compared to the background population. There was significant difference in neonates born large for gestational age (LGA, 90th percentile) in both mGDM and miGDM groups compared to the background population [aOR 2.29 (95% CI 1.88-2.78) and aOR 2.32 (95% CI 1.76-3.07), respectively]. There was not significant difference in LGA (90th percentile) in dGDM compared to the background population [aOR 0.90 (95% CI 0.73-1.12].

Conclusions: These preliminary unpublished results show no increase in SGA for metformin treated GDM compared to the background population. Outcomes in the diet treated GDM group were similar to the background population. Further analyzes are needed to compare outcomes between pharmacologic treatment groups and assess whether specific treatment regimens lead to similar outcomes in different subgroups (eg ethnicity, obesity and glucose values on diagnostic oral glucose tolerance test).

References:

1.Feig DS, Donovan LE, Zinman B, Sanchez JJ, Asztalos E, Ryan EA, et al. Metformin in women with type 2 diabetes in pregnancy (MiTy): a multicentre, international, randomised, placebo-controlled trial. The lancet Diabetes & endocrinology. 2020;8(10):834-44.

2.Fadl H, Saeedi M, Montgomery S, Magnuson A, Schwarcz E, Berntorp K, et al. Changing diagnostic criteria for gestational diabetes in Sweden - a stepped wedge national cluster randomised controlled trial - the CDC4G study protocol. BMC pregnancy and childbirth. 2019;19(1):398.

Place, publisher, year, edition, pages
2023.
Keywords [en]
Gestational diabetes
National Category
Medical and Health Sciences Obstetrics, Gynecology and Reproductive Medicine Endocrinology and Diabetes
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:oru:diva-114096OAI: oai:DiVA.org:oru-114096DiVA, id: diva2:1865939
Conference
Diabetes Pregnancy Study Group (DPSG) Meeting 2023, Poznan, Poland, September 7-9, 2023.
Available from: 2024-06-05 Created: 2024-06-05 Last updated: 2024-06-07Bibliographically approved

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Valgeirsdóttir, Inga RósHildén, KarinPatil, SnehalSimmons, Davidde Brun, MaryamMontgomery, ScottJansson, Stefan P. O.Backman, Helena

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Valgeirsdóttir, Inga RósHildén, KarinPatil, SnehalSimmons, Davidde Brun, MaryamMontgomery, ScottJansson, Stefan P. O.Backman, Helena
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School of Medical SciencesÖrebro University HospitalSchool of Health Sciences
Medical and Health SciencesObstetrics, Gynecology and Reproductive MedicineEndocrinology and Diabetes

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