Metformin for women who are overweight or obese during pregnancy for improving maternal and infant outcomes

Dodd, Jodie M; Grivell, Rosalie M; Deussen, Andrea R; Hague, William

doi:10.1002/14651858.cd010564.pub2

Cited by 49 publications

(51 citation statements)

References 40 publications

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“…On the other hand, obesity during pregnancy increases five times the risk of stillbirths and is associated with placental dysfunction (Nohr et al, 2007). Randomized, double-blind, and placebo-controlled trials, using metformin (1,000 to 3,500 mg per day starting during first trimester) have shown a slight reduction in maternal weight gain in normoglycemic obese pregnant women (Elmaraezy et al, 2017;Dodd et al, 2018;Dodd et al, 2019). However, metformin administration is accompanied with gastrointestinal side effects including nausea, diarrhea, and vomiting (Chiswick et al, 2015;Dodd et al, 2019).…”

Section: Gestational Obesitymentioning

confidence: 99%

Metformin during Pregnancy: Effects on Offspring Development and Metabolic Function

et al. 2020

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Maternal obesity during pregnancy and gestational diabetes mellitus (GDM) are both associated with of several postnatal diseases in the offspring, including obesity, early onset hypertension, diabetes mellitus, and reproductive alterations. Metformin is an oral drug that is being evaluated to treat GDM, obesity-associated insulin resistance, and polycystic ovary syndrome (PCOS) during pregnancy. The beneficial effects of metformin on glycemia and pregnancy outcomes place it as a good alternative for its use during pregnancy. In this line of thought, improving the metabolic status of the pregnant mother by using metformin should avoid the consequences of insulin resistance on the offspring's fetal and postnatal development. However, some human and animal studies have shown that metformin during pregnancy could amplify these alterations and be associated with excessive postnatal weight gain and obesity. In this minireview, we discuss not only the clinical and experimental evidence that supports the benefits of using metformin during pregnancy but also the evidence showing a possible negative impact of this drug on the offspring's development.

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Section: Gestational Obesitymentioning

confidence: 99%

Metformin during Pregnancy: Effects on Offspring Development and Metabolic Function

et al. 2020

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“…We identified all syntheses published in the past 5 years on related or identical topics and discovered that there were nine that we had identified earlier and one that was recently published and discovered while we were revising this paper. None of these syntheses provide a definitive answer to this question, and even though the literature has dramatically changed over the last 5 years, the authors have not kept up with this change.…”

Section: Discussionmentioning

confidence: 99%

“…However, recent randomized trials of women with PCOS or obesity in pregnancy have questioned this effect. In the period between 2012 and 2018, a series of meta‐analyses of both women with and without PCOS (who are at higher risk) attempted to provide additional evidence but fell short because of methodology and culminated in a Cochrane synthesis that was itself inconclusive …”

Section: Introductionmentioning

confidence: 99%

Metformin in pregnancy to avert gestational diabetes in women at high risk: Meta‐analysis of randomized controlled trials

et al. 2019

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Previous randomized and observational studies on the efficacy of metformin in pregnancy to reduce incident gestational diabetes mellitus (GDM) in women at high risk (obesity, polycystic ovary syndrome [PCOS], or pregestational insulin resistance) have been conflicting and several groups are planning further randomized controlled trials (RCTs) to answer this question conclusively. This work assesses the efficacy of metformin in pregnancy to avert one outcome-incident GDM in women at high risk.We included RCTs comparing metformin with usual care or placebo controls in terms of incident GDM and recruiting women at high risk during early pregnancy. Eleven eligible trials enrolled 2370 adult women whose intervention arm consisted of metformin started at conception or before 20 weeks of gestation. Risk of GDM was similar in intervention compared with controls (risk ratio [RR] 1.03; 95% confidence interval [CI], 0.85-1.24). The data were of sufficient quality meeting the criteria for consistency and directness. We conclude that metformin does not contribute to averting the GDM outcome in women at high risk when initiated in pregnancy. The evidence provided by this synthesis affirms that further broad clinical trials investigating this question are no longer needed.

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“…In the combined meta-analysis, there was no significant effect on birthweight and only a modest reduction in gestational weight gain (Elmaraezy et al 2017). A subsequent Cochrane review including data from these two trials and one additional study from Egypt, with outcomes available for 1034 participants overall, concluded that there was insufficient evidence to support the use of metformin for women with obesity in pregnancy for improving maternal and infant outcomes (Dodd et al 2018). Moreover, metformin was associated with increased risk of adverse effects, particularly diarrhoea.…”

Section: Pharmacological Interventionsmentioning

confidence: 96%

Obesity, fertility and pregnancy: can we intervene to improve outcomes?

Reynolds

Gordon

2018

Journal of Endocrinology

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Rates of obesity among women of reproductive age have risen dramatically in recent decades. Obesity impacts on health of women across their reproductive lifespan with adverse effects on not only fertility and short-term complications of pregnancy, but also on longer term health outcomes for both women and their children. This places considerable burden and cost on health services. Here, we review the evidence linking maternal obesity to adverse fertility, pregnancy and longer term health outcomes for women and their children. We discuss the outcomes of recent lifestyle, pharmacological and surgical intervention studies. As many of these studies have not shown a significant improvement in clinical outcomes, we discuss the need for better study design in future trials.

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Metformin for women who are overweight or obese during pregnancy for improving maternal and infant outcomes

Abstract: Metformin for women who are overweight or obese during pregnancy for improving maternal and infant outcomes.

Cited by 49 publications

References 40 publications

Metformin during Pregnancy: Effects on Offspring Development and Metabolic Function

Metformin during Pregnancy: Effects on Offspring Development and Metabolic Function

Metformin in pregnancy to avert gestational diabetes in women at high risk: Meta‐analysis of randomized controlled trials

Obesity, fertility and pregnancy: can we intervene to improve outcomes?

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