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Selected Publication:
Harling, L.
Metformin in pregnancy – long- and short-term consequences for the offspring
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2023. pp. 69
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- Authors Med Uni Graz:
- Harling Lena
- Advisor:
- Hiden Ursula
- Stern Christina
- Altmetrics:
- Abstract:
- Purpose: The usage of Metformin in obstetrics is on the rise, as the oral antidiabetic drug is simple to use and generally well tolerated. The central question, that should be resolved in this thesis is the short- and long-term consequences of the use of metformin in pregnancy for mother and child, which still need to be researched more intensively. Methods: This is a literature research on Metformin in pregnancy, investigating the adverse effects and complications of treatment with Metformin in the context of GDM in comparison with insulin, as well as treatment of PCOS in pregnancy compared with placebo. To conduct the research, the database Pubmed and Google Scholar, as well as randomized controlled trials (RCTs) and meta-analysis from 2000-2022 were used and reviewed concerning quality, relevance, and actuality to find appropriate results. Results: When euglycemic blood sugar control in pregnant women taking Metformin requires additional insulin in some cases lower rates of hypoglycaemic events were reported in women taking Metformin. Compared to insulin it positively influences birth parameters with reducing the incidence of macrosomia and LGA babies, it also seems to be superior to insulin when it comes to neonatal hypoglycaemia. Comparable outcomes between Metformin and insulin were found concerning the incidence of caesarean section and birth trauma. In the context of PCOS a prevention of LGA and SGA babies, as well as preterm birth and miscarriage was seen in women receiving Metformin. Metformin was also seen to prevent preeclampsia in women with GDM and PCOS. Moreover, a favourable effect on gestational weight gain was seen in both GDM and PCOS treatment with Metformin, however it might also lead to a weekly gestational weight gain that is below the recommendations in women with PCOS. While animal models suggest that the exposure to Metformin during pregnancy lead to increased weight of the offspring later in life, even though being smaller at birth, body composition and metabolic outcomes seem to be comparable between toddlers and children whose mothers obtained Metformin to those who were treated with insulin. There is evidence that the treatment with Metformin in women with PCOS might lead to overweight children at the age of 1, 4 and 8 years, however further investigation is needed here. No restriction was seen attributable to Metformin treatment in terms of motor-, social-, linguistic- and neurodevelopment of the infants. Regarding maternal long-term consequences of the treatment with Metformin or insulin because of GDM, neither of the drugs was seen to be able to prevent the onset of T2DM. Furthermore, both drugs led to comparable results in terms of glucose tolerance, HbA1C, weight loss after pregnancy, as well as lipid levels and inflammatory parameters. Conclusion: While Metformin can be considered safe in the short-term, long-term follow-up studies are still required to draw definite conclusions about the safety and effectiveness of the drug and its impact on fetal programming.