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Metformin in pregnancy
Author(s) -
Frier Emily M,
McKay Gerry,
Carty David M
Publication year - 2017
Publication title -
practical diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.205
H-Index - 24
eISSN - 2047-2900
pISSN - 2047-2897
DOI - 10.1002/pdi.2113
Subject(s) - medicine , metformin , pregnancy , gestational diabetes , type 2 diabetes , diabetes mellitus , insulin , adverse effect , obstetrics , type 2 diabetes mellitus , neonatal hypoglycemia , endocrinology , gestation , genetics , biology
178 PRACTICAL DIABETES VOL. 34 NO. 5 COPYRIGHT © 2017 JOHN WILEY & SONS Introduction Up to 5% of pregnant women in the UK have pre-existing diabetes or develop gestational diabetes (GDM). Diabetes in pregnancy is associated with increased risk of obstetric and perinatal complications, and for the mother GDM carries a long-term risk of developing type 2 diabetes mellitus (T2DM) of up to 50%. Even mild hyperglycaemia has been associated with increased rate of fetal loss in early and late pregnancy, as well as congenital defects, accelerated fetal growth and increased risks of shoulder dystocia and birth trauma. The benefits of metformin in treating T2DM, including improved cardiovascular outcomes, are well established. There may also be benefits in adding metformin to insulin-based regimens in type 2 diabetes. The Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study demonstrated a clear linear relationship between maternal glycaemia and adverse perinatal outcomes, in keeping with previous evidence of the benefit of treating even mild maternal hyperglycaemia.1 The conventional treatment for women with GDM inadequately controlled by dietary measures alone is insulin, but metformin has emerged as a safe, acceptable alternative and/or adjunct to insulin therapy and, although it does not currently have marketing authorisation for use in pregnancy, several national guidelines recommend its use in the treatment of both GDM and T2DM in pregnancy.