Metformin Plus Insulin for Preexisting Diabetes or Gestational Diabetes in Early Pregnancy: The MOMPOD Randomized Clinical Trial
In RCT (n=794), metformin added to insulin did not reduce composite outcome of perinatal death, preterm birth, large/small for gestational age [LSFGA] & hyperbilirubinemia requiring phototherapy vs placebo (71% v 74%; aOR 0.86;95% CI 0.63-1.19) but resulted in fewer LFGA infants.
Source:
Journal of the American Medical Association
SPS commentary:
According to an editorial, in the short term, the plurality of data supports a role for metformin in individuals with gestational diabetes and type 2 diabetes during pregnancy, with data from EMERGE suggesting a potential role for the early use of metformin soon after the diagnosis of gestational diabetes. It notes the results of the current study suggest that although still useful in reducing births of large-for-gestational-age infants and improving glycaemic control, other benefits of metformin in those with type 2 diabetes during pregnancy may be diminished in some populations. It points out that an individual participant data meta-analysis is planned, which will hopefully provide a deeper understanding of the effects of metformin.