Archives of Gynecology and Obstetrics

, Volume 292, Issue 1, pp 111–120 | Cite as

Effect comparison of metformin with insulin treatment for gestational diabetes: a meta-analysis based on RCTs

  • Genxia Li
  • Shujun Zhao
  • Shihong CuiEmail author
  • Lei Li
  • Yajuan Xu
  • Yuanyuan Li
Maternal-Fetal Medicine



To compare the effects of metformin with insulin on maternal and neonatal outcomes in gestational diabetes mellitus (GDM).


A literature search in PUBMED, EMBASE, Science Direct, Springer link, and Cochrane library was conducted using the following search terms: “Gestational Diabetes” or “GDM”, and “insulin” and “metformin”. Quality assessment of included studies was determined with Quality Assessment of Diagnostic Accuracy Studies. Review Manger 5.2 was used to analyze mean difference (MD)/risk ratio (RR) and 95 % confidence interval (CI) in random-effects model or fixed-effects model depending on the level of heterogeneity.


A total of 11 studies were identified. There was no significant difference of the effect on maternal outcomes between the two treatments in glycohemoglobin A1c levels (P = 0.37), fasting blood glucose (P = 0.66), and the incidence of preeclampsia (P = 0.26); whereas, significantly reduced results were found in the metformin group in pregnancy-induced hypertension (PIH) rate (RR = 0.53, 95 % CI 0.31–0.90, P = 0.02), average weight gains after enrollment (MD = −1.28, 95 % CI −1.54 to −1.01, P < 0.0001), and average gestational ages at delivery (MD = 0.94, 95 % CI −0.21 to −0.01, P = 0.03). Regarding neonatal outcomes, when compared with insulin group, metformin presented significantly lower average birth weights (MD = −44.35, 95 % CI −85.79 to −2.90, P = 0.04), incidence of hypoglycemia (RR = 0.69, 95 % CI 0.55–0.87, P = 0.001) and neonatal intensive care unit (NICU) (RR = 0.82, 95 % CI 0.67–0.99, P = 0.04).


Metformin can significantly reduce several adverse maternal and neonatal outcomes including PIH rate, incidence of hypoglycemia and NICU, thus it may be an effective and safe alternative or additional treatment to insulin for GDM women.


Gestational diabetes Metformin Insulin Meta-analysis 


Conflict of interest

The authors declare that they have no conflicts of interest to disclose.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Genxia Li
    • 1
  • Shujun Zhao
    • 1
  • Shihong Cui
    • 1
    Email author
  • Lei Li
    • 1
  • Yajuan Xu
    • 1
  • Yuanyuan Li
    • 1
  1. 1.Department of Obstetrics and GynecologyThe Third Affiliated Hospital of Zhengzhou UniversityZhengzhouPeople’s Republic of China

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