Effect of Metformin on Diabetes Mellitus Prevention in Pregnant Women with Risk Factors
-
Shirin Niroomanesh
,
Masoumeh Dadashaliha
,
Farahnaz Ahmadi
,
Fatemeh Rahimi Sherbaf
,
Forough Forghani
Abstract
Objective: This study evaluated the efficacy and safety of metformin on prevention of gestational diabetes mellitus in women with high risk of GDM.
Materials and methods: Total number of 189 pregnant women aged between 25 to 35, and 10 to 14 weeks pregnancy,admitted to Mirza Koochakkhan Hospital, Tehran in January 2008 - January 2009 entered to this randomized controlled clinical trial. The women had one of the three risk factors; history of GDM, family history of diabetes, or BMI ≥ 30 kg/m2, with normal results in the glucose challenge test (GCT) or the glucose tolerance test (GTT). Subjects were randomly split to two groups; 63 women (group A) who received metformin (500 mg, twice a day) and 126 women (group B) did not use metformin. Incidence of gestational diabetes was compared between two groups.
Results: The incidence of gestational diabetes was significantly different between two groups (%1.4 in group A, %15.4 in group B) (p<0.001). The study also showed that the insulin requirement was significantly different between two groups after developing GDM (group A %3.6, group B %9.5, p=0.001).
Conclusion: Using Metformin can effectively reduce the incidence of GDM in pregnant women at risk.
Canadian Diabetes Association Clinical practice Guidelines Expert Committee: Canadian Diabetes Association clinical practice guidelines for the preventation and management of diabets in Canada. Can J Diabetes 2003; 27 suppl 2: S99–105.
American Diabetes Association: Gestational diabets melitus. Diabetes Care 2004; 27 suppl 1: S88–90.
Gunningham FG,Ga nt NF, leveno KJ, Gilstrap LC, Hauth JC, wenstron KD, et al. Williams Obstetrrics. 21st Ed. New York. McGraw Hill; 2001.
Larijani B, Hosseinnezhad A. Diabetes mellitus and pregnancy. Iranian Journal of diabetes and lipid Disorders 1380; 1: 22–9.
Atral R. Exercise: The alternative therapeutic intervention for gestational diabetes. Clin Obstet Gynecol 2003; 46: 479–87.
Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, and Hadden DR, et al. Summary and recommendations of the fifth International Workshop Conference on Gestational Diabetes mellitus. Diabetes Care 2007; 30 suppl 2: S251–60.
Dornhorst A, Rossi M. Risk and prevention of type 2 diabetes in women with gestational diabetes. Diabetes Care 1998; 21: B43–9.
Jovanovic L. what is so bad about a big baby: Diabetes Care 2001; 24: 1317–8.
Harris SB, Caulfield L, Sugamori M, Whalen EA, Henning B. The epidemiology of diabetes in pregnant native Canadians. A risk profile. Diabetes care 1997; 20: 1422–5.
Rodrigues S, Robinson E, Gary–Donald K. Prevalence of gestational diabetes mellitus among James Bay Cree women in northern Quebec. Can Med Assoc J 1999; 160: 1293–7.
Kelly C, Booth Gl. Diabetes in Canadian womens. BMC Womens Health 2004; 4 Suppl 1: S16–24.
Ben–Haroush A, Yogev Y, Hod M. epidemiology of gestational diabetes and its association with type 2 diabetes. Diabetic Medicine 2004, 21: 103–13.
Yogev Y, Xenakis E, langer O. The association between preeclampcia and the severity of gestational diabetes: The impact of glycemia control. Am J obstet Gynecol 2004, 191: 1655–60.
Catalano P, Thomas A, Huston–Presley L, Amini S. Increased fetal adiposity: A very sensitive marker of abnormal in utero development. Am J Obstet Gynecol 2003, 189: 1698–704.
Linne Y. Effects of obesity on women’s reproduction and complications during pregnancy. Obesity Reviews 2004; 5: 137–43.
Bailey CJ, Turner RC. Metformin. N Engl J Med 1996; 334: 574–9.
Krentz AJ, Bailey CJ. Oral antidiabetic agents: current role in type 2 diabetes mellitus. Drugs 2005; 65: 385–411.
Kirpichnikov D, McFarlane SI, Sowers JR. Metformin: An update. Ann Intern Med 2002;137:25–33.
Cusi K, Consoli A, DeFronzo RA. Metabolic effects of metformin on glucose and lactate metabolism in noninsulin–dependent diabetes mellitus. J Clin Endocrinol Metab 1996; 81: 4059–67.
Gilbert C, Valois M, Koren G. Pregnancy outcome after first–trimester exposureto metformin: A meta– analysis. Fertil Steril 2006; 86: 658–63.
Glueck CJ, Wang P, Kobayashi S, Phillips H, Sieve– Smith L. Metformin therapy throughout pregnancy reduces the development of gestational diabetes in women with polycystic ovary syndrome. Fertil Steril 2002; 77: 520–5.
Glueck CJ, Goldenberg N, Wang P, Loftspring M, Sherman A. Metformin during pregnancy reduces insulin, insulin resistance, insulin secretion, weight, testosterone and development of gestational diabetes: Prospective longitudinal assessment of women with polycystic ovary syndrome from preconception throughout pregnancy. Hum Reprod 2004; 19: 510–21.
Jakubowicz DJ, Iuorno MJ, Jakubowicz S, Roberts KA, Nestler JE. Effects of metformin on early pregnancy loss in the polycystic ovary syndrome. J Clin Endocrinol Metab 2002; 87: 524–9.
Vanky E, Stridsklev S, Heimstad R, Romundstad P, Skogøy K, Kleggetveit O, et al. Metformin versus placebo from first trimester to delivery in polycystic ovary syndrome: A randomized,controlled multicenter study. J Clin Endocrinol Metab 2010; 95: E448–55.
Balani J, Hyer SL, Rodin DA, Shehata H. Pregnancy outcomes in women with gestational diabetes treated with metformin or insulin: A case–control study. Diabet Med 2009; 26: 798–802.
Nicholson W, Bolen S, Witkop CT, Neale D, Wilson L, Bass E. Benefits and risks of oral diabetes agents compared with insulin in women with gestational diabetes:a systematic review. Obstet Gynecol 2009; 113: 193–205.
| Files | ||
| Issue | Vol 4, No 4 (December 2010) | |
| Section | Original Articles | |
| Keywords | ||
| Gestational diabetes mellitus Metformin Prevention | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
