A Pilot Randomized, Controlled Trial of Metformin versus Insulin in Women with Type 2 Diabetes Mellitus during Pregnancy

Jerrie S. Refuerzo; Rose Gowen; Claudia Pedroza; Maria Hutchinson; Sean C. Blackwell; Susan Ramin

doi:10.1055/s-0034-1378144

American Journal of Perinatology, Table of Contents

Am J Perinatol 2015; 32(02): 163-170
DOI: 10.1055/s-0034-1378144

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Pilot Randomized, Controlled Trial of Metformin versus Insulin in Women with Type 2 Diabetes Mellitus during Pregnancy

Authors

Jerrie S. Refuerzo

¹Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas
Rose Gowen

²Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Brownsville, Brownsville, Texas
Claudia Pedroza

³Center for Clinical Research and Evidence-Based Medicine, University of Texas Health Science Center at Houston, Houston, Texas
Maria Hutchinson

¹Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas
Sean C. Blackwell

¹Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas
Susan Ramin

⁴Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas

Abstract

Objective Few studies support oral diabetic treatment in pregnant women with type 2 diabetes mellitus (T2DM). The objective of this study was to compare the effects of metformin versus insulin on achieving glycemic control and improving maternal and neonatal outcomes in pregnant women with T2DM.

Study Design A pilot randomized, controlled trial was conducted of metformin versus insulin for the treatment of T2DM during pregnancy. The primary outcome was glycemic control measured with hemoglobin A1c < 7% at delivery. Maternal and neonatal outcomes were compared between groups.

Results In this study, 8 women received metformin and 11 received insulin. All women in both groups achieved glycemic control by delivery (HgbA1c: metformin 5.96 ± 5.88 vs. insulin 6.34 ± 0.92%). There were similar rates of cesarean delivery, birth weights, neonatal intensive care unit admissions, respiratory distress syndrome, and neonatal dextrose treatment between groups. There was one case of fetal macrosomia in the insulin group, one case of shoulder dystocia in the metformin group and no cases of failed metformin therapy.

Conclusion In this pilot study, glycemic control was achieved in women who received metformin and insulin. Larger studies are needed to determine whether metformin can be considered a reasonable alternative to insulin in pregnant women with T2DM.

Keywords

type 2 diabetes mellitus - pregnancy - metformin

Full Text

References

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