Metformin has a place in gestational diabetes. Don’t stop it.

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Goodfellow Gems

"Metformin has a place in gestational diabetes. Don’t stop it."

A systematic review in the latest Alberta Tools for Practice1 found that compared with insulin, metformin treatment for women with gestational diabetes (GDM) results in 1kg less maternal weight gain and less severe neonatal hypoglycaemia for one in 22 babies, but results in earlier delivery by about one day. Other clinical outcomes are unchanged and long-term safety of metformin in GDM appears reassuring. Metformin is a reasonable treatment option for women with GDM.  However, supplemental insulin is required in 14-46% of women, depending on population characteristics and glucose targets. For women with established type 2 diabetes prior to conception, insulin is usually required to achieve pregnancy glucose targets, but many women also continue metformin through pregnancy. Do not stop metformin when a woman conceives, as hyperglycaemia is teratogenic, but metformin is not.

This gem has been checked by Dr Janet Rowan, Maternal Medicine Specialist Auckland City Hospital Auckland New Zealand

References:

  1. https://www.acfp.ca/wp-content/uploads/tools-for-practice/1444404372_tfp...

Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.


As published in NZ Doctor 25/11/2015