TOWARDS DEFINING CRITERIA FOR METFORMIN USAGE IN MANAGEMENT OF GESTATIONAL DIABETES MELLITUS
Hamidreza Mahboobi1, 2, Tahereh Khorgoei3, Aida Najafian1
1: Reproductive Health Research Center, Hormozgan University of Medical Sciences (HUMS), BandarAbbas, Iran2: Payame Noor University (PNU), Iran3: Hormozgan Cardiovascular Research Center, Hormozgan University of Medical Sciences (HUMS),Bandar Abbas, Iran
Corresponding author: Hamidreza Mahboobi, Hormozgan University of Medical Sciences (HUMS), Bandar Abbas, Iran. Phone: + 98. 9364300250, E-mail: [email protected] Bibliographic information of this paper for citing: Hamidreza Mahoobi, Tahereh Khorgoei, and Aida Najafian. Towards defining criteria for metformin usage in management of Gestational Diabetes Mellitus. Electron. Pysicician 2010, 2:81-84, Available at: http://www.ephysician.ir/2010/81-84.pdf
Received: 26 June 2010Revised: 03 July 2010Accepted: 05 July 2010Published: 07 July 2010 2009-2010 Electronic Physician
Keywords: Gestational diabetes mellitus; Metformin Dear Editor,
(2). Without treatment, GDM is associatedwith
complications (3). Insulin is commonly used
pregnancies (1), and pregnancy outcomes in
glycemic control with medical nutritional
GDM are strongly related to glucose control
lowering the blood glucose as well as being
teratogenic, and did not adversely affect
birth length and weight, growth, or motor
social development in the first 18 months of
educating with regard to insulin injection
before they start using it, and there is alsoalways a chance of hypoglycemia in these
Although metformin seems to be as effective
patients. Moreover, insulin resistance and
as insulin in management of patients with
insulin, there are still concerns about its
safety in neonates. Randomized controlled
have lead to increasing interest for the usage
trials assessing metformin safety in neonates
of oral hypoglycemic agents in the treatment
and long-term follow-up of these neonates is
lacking. Insulin is still the drug of choice in
oral agents are easier to administer than
up of metformin effects on neonates could
insulin in clinical practice (11). However,
change this role and may revolutionize the
there are concerns that oral agents can cross
should consider that specific patients such as
teratogenesis and other fetal complications,
resistance (24) may benefit more than others
resistance, remains unclear (7, 12).
should be carried out on specific patients in
induction of ovulation in PCOS patients (13)
and is associated with a reduction ingestational
pharmacokinetics of metformin in pregnantwomen is similar to those in non-pregnant
patients (12). Metformin was found to bereadily transferable from the maternal tofetal circuits across placentas that were
Epidemiology of gestational diabetes mellitus
and its association with Type 2 diabetes.
study showed that preeclampsia and prenatal
Diabetic Medicine. 2004;21(2):103-13.
mortality are more common in patients who
were treated with metformin in comparison
HD. Glycemia and its relationship to outcomes
in the metformin in gestational diabetes trial.
these findings (21). Potential hypoglycemicagents have been shown to have no adverse
3. Langer O, Yogev Y, Most O, Xenakis EMJ.
Gestational diabetes: The consequences of not
have additional benefits, including reducing
treating. American Journal of Obstetrics and
insulin resistance, body weight, long term
risk of diabetes (23), and development of
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2004 January 2004;27(suppl 1):s88-s90.
throughout pregnancy reduces the development
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of gestational diabetes in women with polycystic
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15. Stadtmauer LA, Wong BC, Oehninger S.
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Should patients with polycystic ovary syndrome
Gutierrez M, Bowsher RR, et al. Metabolic and
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16. Glueck CJ, Wang P, Goldenberg N, Sieve-
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Loftspring M, Sieve L, Wang P. Height, weight,
and motor-social development during the first 18months of life in 126 infants born to 109
11. Carles G, Germain L, Alassas N, El Guindi
mothers with polycystic ovary syndrome who
conceived on and continued metformin through
gestational diabetes with oral hypoglycemic
pregnancy. Hum Reprod. 2004 Jun;19(6):1323-
agents]. J Gynecol Obstet Biol Reprod (Paris).
19. Nanovskaya TN, Nekhayeva IA, Patrikeeva
12. Charles B, Norris R, Xiao X, Hague W.
Population pharmacokinetics of metformin in
metformin across the dually perfused human
placental lobule. Am J Obstet Gynecol. 2006
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Rotmensch S, Glezerman M. Neonatal outcome
Oral hypoglycaemic agents in 118 diabetic
in polycystic ovarian syndrome patients treated
pregnancies. Diabet Med. 2000 Jul;17(7):507-
with metformin during pregnancy. J Matern
Fetal Neonatal Med. 2006 Jul;19(7):415-9.
14. Glueck CJ, Wang P, Kobayashi S, Phillips
outcomes in women with polycystic ovarysyndrome. Diabet Med. 2004 Aug;21(8):829-36.
Diagnosis and new approaches in the therapy ofgestational diabetes mellitus. Curr Diabetes Rev. 2006 Aug;2(3):343-52.
23. Hawthorne G. Metformin use and diabeticpregnancy-has its time come? Diabet Med. 2006Mar;23(3):223-7.
24. Simmons D, Walters BN, Rowan JA,McIntyre HD. Metformin therapy and diabetesin
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