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#Diabetes and Endocrinology
Use of insulin for managing type 2 diabetes in pregnancy may have some limitations such as injection phobia. On the other hand, despite reported safety of metformin in pregnant women with polycysticovary syndrome, gestational diabetes mellitus and obesity by some studies, its use in pregnancy remains controversial due to its ability to cross placenta and dearth of data regarding its impact on the fetus. With regard to this, a retrospective study was conducted that compared pregnancy outcomes inwomen with preexisting type 2 diabetes receiving metformin with those receiving standard insulin therapy. The study cohort comprised women of age 20-44 years with preexisting type 2 diabetes and singleton pregnancies in Taiwan between 2003 and 2014. These participants were categorized into 3 mutually exclusive groups based on the glucose-lowering treatments they received before and after becoming pregnant: insulin group, switching group (metformin to insulin), and metformin group. A generalized estimating equation modelad justed for patient age, duration of type 2 diabetes, hypertension, hyperlipidemia, retinopathy, and aspirin use was employed to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) of adverse pregnancy outcomes. The study findings showed that 1,166 pregnancies were identified in the insulin group (n = 222), the switching group (n = 318) and the metformin group (n = 626). Pregnancy outcomes for both the mother and fetus were similar in the insulin group and the switching group, including risk of primary cesarean section, pregnancy-related hypertension, preeclampsia, preterm birth (< 37 weeks), very preterm birth (< 32 weeks), low birth weight (< 2,500 g), high birthweight (> 4,000 g), large for gestational age, and congenital malformations. It is noteworthy that the metformin group had a lower risk ofprimary cesarean section (aOR = 0.57; 95% CI, 0.40–0.82) and congenital malformations (aOR, 0.51; 95% CI; 0.27–0.94). However, risk for other outcomes was similar to the insulin group. The researchers of this study thus concluded that use of metformin when compared to standard insulin therapy does not increase adverse pregnancy outcomes in women withtype 2 diabetes.
Shu-Fu Lin, Shang-Hung Chang, Chang-Fu Kuo, et al. Association of pregnancy outcomes in women with type 2 diabetes treated with metformin versus insulin when becoming pregnant. BMC Pregnancy and Childbirth. 2020;20:512.