The emerging role of metformin in gestational diabetes mellitus
Abstract
Metformin use during pregnancy is controversial and there is disparity in the acceptance of metformin treatment in women with gestational diabetes mellitus (GDM) in Australia. Despite short term maternal and neonatal safety measures, the placental transfer of metformin during GDM treatment and the absence of long-term safety data in offspring has regulators and prescribers cautious about its use. To determine the current role in GDM management, this literature review describes the physiological changes that occur in GDM and other forms of diabetes in pregnancy (DIP) and international changes in guidelines for GDM diagnosis. Management options are considered, with a focus on the evolving evidence for metformin, its mechanism of action, the maternal, foetal and neonatal outcomes associated with its use and benefit vs risk when compared with the current gold standard, insulin. Investigation reveals a favourable balance of evidence to support the safety and long-term benefits, to mother and child, of using metformin as an alternate to insulin for treatment of GDM. Recent findings of the gastrointestinal-directed action of metformin are at least as important as the hepatic effect and the availability of a novel delayed-release metformin dose form to exploit this new information provides a product and therapeutic strategy ideally suited to the use of metformin in GDM.
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Metformin is currently classified as category B in the United States and as category C in Australia.
“and is currently classified as category B in the United States and as category C in Australia (247, 248).”
From Metformin, the Aspirin of the 21st Century: Its Role in Gestational Diabetes Mellitus, Prevention of Preeclampsia and Cancer, and the Promotion of Longevity (2017) · cites this paper as [247]
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- Authors
- Gray, S. G., McGuire, T. M., Cohen, N., & Little, P. J.
- Affiliations
- The University of Queensland (AU)
- Bond University (AU)
- Baker Heart and Diabetes Institute (AU)
- Sun Yat-sen University (CN)
- Corresponding author
- Little, Peter J.
- Venue
- Diabetes Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2017-03-24
- Volume
- 19
- Issue
- 6
- Pages
- 765-772
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- OpenAlex
- W2583026286
- Cited by
- 40
- References
- 83
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 4 · 2022: 5 · 2021: 5 · 2020: 6 · 2019: 4 · 2018: 10 · 2017: 3 · 2016: 1
- FWCI
- 1.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Obesity and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Bond University Research Portal (Bond University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- metformin, gestational diabetes mellitus, diabetes in pregnancy, placental transfer, maternal and neonatal safety, long-term offspring outcomes, insulin therapy, drug safety in pregnancy
- MeSH terms
- Australia, Female, Humans, Hypoglycemic Agents, Insulin, Metformin, Pregnancy, Pregnancy in Diabetics, Pregnancy Outcome, Prenatal Exposure Delayed Effects, Diabetes, Gestational
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