Metformin in Gestational Diabetes Mellitus: To Use or Not to Use, That Is the Question

Abstract

In recent years, there has been a dramatic increase in the number of pregnancies complicated by gestational diabetes mellitus (GDM). GDM occurs when maternal insulin resistance develops and/or progresses during gestation, and it is not compensated by a rise in maternal insulin secretion. If not properly managed, this condition can cause serious short-term and long-term problems for both mother and child. Lifestyle changes are the first line of treatment for GDM, but if ineffective, insulin injections are the recommended pharmacological treatment choice. Some guidance authorities and scientific societies have proposed the use of metformin as an alternative pharmacological option for treating GDM, but there is not yet a unanimous consensus on this. Although the use of metformin appears to be safe for the mother, concerns remain about its long-term metabolic effects on the child that is exposed in utero to the drug, given that metformin, contrary to insulin, crosses the placenta. This review article describes the existing lines of evidence about the use of metformin in pregnancies complicated by GDM, in order to clarify its potential benefits and limits, and to help clinicians make decisions about who could benefit most from this drug treatment.

Developmental metformin exposure does not rescue physiological impairments derived from early exposure to altered maternal metabolic state in offspring mice

“…Moreover, an increased risk of being born small for gestational age (SGA) [ 24 ] was also observed in children with prenatal metformin exposure. Altogether, these data suggest a potential developmental programming role for metformin, as highlighted in recent reviews [ 25 , 26 ].…”

Interaction and Metabolic Pathways: Elucidating the Role of Gut Microbiota in Gestational Diabetes Mellitus Pathogenesis

“…These findings highlight the diverse impact of MET, which extends beyond glucose metabolism to include significant effects on the composition and metabolic functions of gut microbiota. This provides insights into the potential systemic health implications of the drug [ 26 ].…”