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#Grand Rounds

Prenatal Metformin vs. Insulin for GDM: Impact on Child Growth and Development

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BACKGROUND AND PURPOSE: 

  • Most follow-up studies comparing metformin to insulin for treatment of GDM have been up to 2 years of age  
  • Landi et al. (JAMA Pediatrics, 2018) looked at growth and development through 4 years of age

METHODS: 

  • Retrospective population-based cohort study (2005-2012) 
    • National Maternity Collection (MAT) database that links mothers and offspring  
  • Women were treated with either (initially monotherapy) 
    • Metformin 
    • Insulin 
  • Primary outcome 
    • Growth: Weight and height to derive BMI and weight for height differences   
    • Behavioral Development: Strengths and Difficulties Questionnaire (SDQ) scores with following target areas 
      • Prosocial behavior | Hyperactivity | Emotional symptoms | Conduct | Peer problems 
  • Results were adjusted for confounders

RESULTS: 

  • 1996 in metformin group | 1932 in insulin group 
    • Maternal age in overall cohort: 32 years 
  • No weight for height difference between children exposed to metformin compared vs insulin  
    • Mean difference -0.10 (95% CI, -0.20 to 0.01) 

Comparing metformin to insulin 

  • No difference in risk of being ≥85th percentile for weight for height  
    • Adjusted risk ratio 0.92 (95% CI, 0.83-1.02) 
  • No significant difference in Mean SDQ scores  
  • No significant difference in high (abnormal) SDQ scores  
    • Adjusted risk ratio 1.13 (95% CI, 0.88-1.46)  

CONCLUSION: 

  • With respect to growth and behavior, no significant differences were found when comparing metformin and insulin treatment for GDM with 4-year follow up

Learn More – Primary Sources:

Association of Long-term Child Growth and Developmental Outcomes With Metformin vs Insulin Treatment for Gestational Diabetes

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Related ObG Topics:

Updated ACOG Guidance on Gestational Diabetes
ACOG and SMFM Both Release Guidance on Gestational Diabetes – Insulin vs Metformin for First-Line Therapy?
Metformin in Pregnancy
EUROmediCAT Data: Does Metformin Use in the First Trimester of Pregnancy Increase the Risk for Congenital Anomalies?

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