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Metformin in overweight and obese women with gestational diabetes: a propensity score-matched study

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Abstract

Purpose

Obesity and gestational diabetes mellitus (GDM) have an independent negative impact in pregnancy outcomes. Excessive gestational weight gain (GWG) represents an additional high-risk condition for adverse outcomes. The aims of this study were to evaluate the potential effect of metformin in GWG in overweight or obese women with GDM, to report our experience and to assess metformin’s safety in this population.

Methods

Retrospective observational cohort study involving pregnant women with GDM and pregestational overweight or obesity. Demographic, anthropometric, glycemic control data, obstetric, fetal and neonatal outcomes were evaluated. The sample was divided into two groups according to metformin treatment. A propensity score-matched analysis was performed using age, initial body mass index (BMI), trimester at GDM diagnosis and previous history of GDM or macrosomia as covariates.

Results

Of the 457 enrolled in the study, 177 (38.7%) were treated with metformin. Two groups of 130 well matched patients were balanced regarding baseline characteristics. Women in metformin group had significantly less excessive GWG (29.23% vs. 42.31%, OR 0.56, 95% CI 0.34–0.94, p = 0.028) and more adequate GWG (36.92% vs. 23.08%, OR 1.95, 95% CI 1.14–3.35, p = 0.015). No significant differences were found between both groups regarding glycemic control, rate of insulinization, and obstetric, fetal, and neonatal outcomes.

Conclusions

This study highlights metformin as an important and safe tool to prevent excessive GWG and promote adequate GWG in overweight or obese women with GDM, regardless of age, BMI, timing of GDM diagnosis, previous history of GDM or macrosomia.

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Acknowledgements

We would like to acknowledge all the endocrinologists, obstetricians, nutritionists and nurses of the Outpatient Clinic of Obstetrics and Endocrinology.

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Authors and Affiliations

  1. Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário S. João, Porto, Portugal

    Rita Bettencourt-Silva, João Sérgio Neves, Maria João Ferreira, Pedro Souteiro, Sandra Belo, Ana Isabel Oliveira, Davide Carvalho & Joana Queirós

  2. Faculty of Medicine of University of Porto, Porto, Portugal

    Rita Bettencourt-Silva, João Sérgio Neves, Maria João Ferreira, Pedro Souteiro, Davide Carvalho, Gabriela Namora & Nuno Montenegro

  3. Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal

    Rita Bettencourt-Silva, João Sérgio Neves, Maria João Ferreira, Pedro Souteiro & Davide Carvalho

  4. Outpatient Clinic of Obstetrics and Endocrinology, Centro Hospitalar Universitário S. João, Porto, Portugal

    Sandra Belo, Ana Isabel Oliveira, Gabriela Namora, Nuno Montenegro & Joana Queirós

  5. Diabetes and Pregnancy Study Group, Portuguese Society of Diabetology, Porto, Portugal

    Sandra Belo & Joana Queirós

  6. Department of Obstetrics and Gynecology, Centro Hospitalar Universitário S. João, Porto, Portugal

    Gabriela Namora & Nuno Montenegro

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  1. Rita Bettencourt-Silva
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  2. João Sérgio Neves
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  3. Maria João Ferreira
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Correspondence to Rita Bettencourt-Silva.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the Declaration of Helsinki on medical protocol and ethics. The study was approved by Diabetes and Pregnancy Study Group of the Portuguese Society of Diabetology.

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For this type of study using retrospective and anonymized data, participants’ written consent was not required.

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Bettencourt-Silva, R., Neves, J.S., Ferreira, M.J. et al. Metformin in overweight and obese women with gestational diabetes: a propensity score-matched study. Endocrine 66, 192–200 (2019). https://doi.org/10.1007/s12020-019-02043-3

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