Rita Bettencourt-Silva1,2,3, João Sérgio Neves4,5,6, Maria João Ferreira4,5,6, Pedro Souteiro4,5,6, Sandra Belo4,7,8, Ana Isabel Oliveira4,7, Davide Carvalho4,5,6, Gabriela Namora5,7,9, Nuno Montenegro5,7,9, Joana Queirós4,7,8. 1. Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário S. João, Porto, Portugal. ritabettsilva@gmail.com. 2. Faculty of Medicine of University of Porto, Porto, Portugal. ritabettsilva@gmail.com. 3. Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal. ritabettsilva@gmail.com. 4. Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário S. João, Porto, Portugal. 5. Faculty of Medicine of University of Porto, Porto, Portugal. 6. Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal. 7. Outpatient Clinic of Obstetrics and Endocrinology, Centro Hospitalar Universitário S. João, Porto, Portugal. 8. Diabetes and Pregnancy Study Group, Portuguese Society of Diabetology, Porto, Portugal. 9. Department of Obstetrics and Gynecology, Centro Hospitalar Universitário S. João, Porto, Portugal.
Abstract
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.
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 obesewomen 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 obesewomen with GDM, regardless of age, BMI, timing of GDM diagnosis, previous history of GDM or macrosomia.
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