Safe treatment of gestational diabetes

Although metformin crosses the placenta and produces similar plasma concentrations in mother and fetus, it is safe for use during pregnancy (Category B  according to FDA classification).

In addition, hyperglycemia in pregnant women is a proven risk factor for congenital anomalies, so it is reasonable to use metformin for the treatment of gestational diabetes.

Read the article on estet-portal.com about efficacy and safety studies taking metformin during pregnancy.

• Studies on Metformin versus Insulin
• Long-term effects of metformin on child development after treatment
• Metformin and neoplasms of the female genital organsin

Metformin versus insulin studies

In the JA Rowan study, women with gestational diabetes were randomized to receive metformin or insulin.

Metformin treatment was well tolerated, gastrointestinal adverse reactions were the reason for discontinuation of the drug in only 1.9% of patients.

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Importantly, the incidence of severe hypoglycemia (<1.6 mmol/l) was significantly lower in the metformin group.

Metformin treatment was well received by patients: 76.6% of women expressed a desire to take metformin during the next pregnancy.

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Metformin was also associated with less weight gain during pregnancy compared to a group of women who used insulin to correction of gestational diabetes .  

 

 

A meta-analysis studies in women who were previously diagnosed with polycystic ovary syndrome showed that treatment with metformin was associated with a 14% reduction in the risk of congenital anomalies.

A recent meta-analysis confirmed the safety of metformin as 1st line therapy for gestational diabetes, as well as the preference for metformin over the other single oral antidiabetic drug previously approved for use in pregnancy, − glibenclamide.

Most women with type 2 diabetesdiagnosed before pregnancy require continued metformin treatment during pregnancy to maintain glycemic control (especially in the III trimester when there is a physiological increase insulin resistance).

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According to Hughes and Rowan, metformin treatment in women with pregestational type 2 diabetes  was not associated with worsening of any pregnancy outcomesand.

Long-term effects of metformin on child development after treatment

In a large study MiG TOFU evaluated the long-term prognosis of metformin in utero exposure compared to the    insulin therapy.

According to this study, at 2 years of age, children who received metformin in utero had a thicker skinfold in the area of ​​the shoulder and scapula compared with children whose mothers received insulin therapy during pregnancy; while the total fat content was the same in both groups.

This indicates a more favorable  

type of distribution of adipose tissue (by subcutaneous rather than visceral type) in the treatment with metformin.

Another 

prospective study in children of mothers with polycystic ovary syndrome who took metformin starting early in pregnancy, showed no adverse effect on anthropometric data, motor activity and behavioral responses in these children at 18 monthsc.

Metformin and female genital neoplasms

By reducing the carcinogenic effects 

obesity and insulin resistance Metformin can be used for long-term chemoprophylaxis in women at increased risk of endometrial cancer  and breast.

This group primarily includes women with:

polycystic ovary syndrome;
morbid obesity;
impaired glucose tolerance;
endometrial hyperplasia.

In addition to influencing body weight and insulin resistance, metformin can regulate 

the cell cycle by interacting with classical oncogenes and tumor suppressors.

For example, metformin has been shown to induce AMPK-dependent downregulation of  

c-MYC in breast cancer cell lines.

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This effect is mediated by increased miRNA expression, which, in turn, is mediated by increased regulation 

of the RNase enzyme III Dicer in response to treatment with metformin.

Modulation Dicer by metformin is of particular importance given that low levels of this enzyme are associated with a poor prognosis in ovarian, breast, and lung cancer.

Metformin has also been found to disrupt folate and methionine metabolism in  

breast cancer cells with a simultaneous decrease in glutathione and tryptophan metabolites.

In a study in women with 

endometrial cancer overall survival was significantly better in patients with type 2 diabetes treated with metformin compared to women with diabetes or without diabetes who were not taking metformin.

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This correlation was 

statistically significant after adjusting for age, clinical stage of cancer, histologic grade, and use of adjuvant therapy.

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