Metformin in overweight and obese women with gestational diabetes: a propensity score-matched study

PURPOSE

Obesity and gestational diabetes mellitus (GDM) have an independent negative impact in pregnancy outcomes. Excessive gestational weight gain (GWG) represents an additional high-risk condition for adverse outcomes. The aims of this study were to evaluate the potential effect of metformin in GWG in overweight or obese women with GDM, to report our experience and to assess metformin's safety in this population.

METHODS

Retrospective observational cohort study involving pregnant women with GDM and pregestational overweight or obesity. Demographic, anthropometric, glycemic control data, obstetric, fetal and neonatal outcomes were evaluated. The sample was divided into two groups according to metformin treatment. A propensity score-matched analysis was performed using age, initial body mass index (BMI), trimester at GDM diagnosis and previous history of GDM or macrosomia as covariates.

RESULTS

Of the 457 enrolled in the study, 177 (38.7%) were treated with metformin. Two groups of 130 well matched patients were balanced regarding baseline characteristics. Women in metformin group had significantly less excessive GWG (29.23% vs. 42.31%, OR 0.56, 95% CI 0.34-0.94, p = 0.028) and more adequate GWG (36.92% vs. 23.08%, OR 1.95, 95% CI 1.14-3.35, p = 0.015). No significant differences were found between both groups regarding glycemic control, rate of insulinization, and obstetric, fetal, and neonatal outcomes.

CONCLUSIONS

This study highlights metformin as an important and safe tool to prevent excessive GWG and promote adequate GWG in overweight or obese women with GDM, regardless of age, BMI, timing of GDM diagnosis, previous history of GDM or macrosomia.

Gestational diabetes mellitus: a risk factor for non-elective cesarean section

AIM

To assess whether gestational diabetes mellitus (GDM) is associated with non-elective cesarean section.

MATERIAL AND METHODS

A retrospective cohort study was conducted at the Department of Obstetrics of a level III hospital. Between January 2004 and November 2007, women admitted in labor or with spontaneous rupture of membranes, at term, and with a singleton cephalic presenting fetus were eligible. From these, 220 women with GDM and 660 glucose-tolerant women, delivered immediately after, were selected. The association between GDM and non-elective cesarean was estimated using modified Poisson regression analysis. Relative risks were adjusted for age, pre-pregnancy body mass index, gestational weight gain, previous cesarean, gestational age at delivery and birthweight.

RESULTS

Non-elective cesarean section rate for women with GDM was 19.5% compared to 13.5% for non-diabetic women. The crude relative risk of cesarean section was 1.45 (95% CI 1.04-2.02) for women with GDM. After adjustment for confounders, the association between GDM and non-elective cesarean section remained positive and statistically significant (RR = 1.52; 95% CI 1.06-2.16). No significant differences in cesarean indications were found between the two groups.

CONCLUSION

GDM was disclosed as a risk factor for non-elective cesarean section. Knowledge of the condition may have influenced obstetrical practice, favoring cesarean delivery.