Metformin Use During Pregnancy for Gestational diabetes May effect Babies Growth Patterns

Gestational diabetes mellitus (GDM) is a type of diabetes that can develop during pregnancy in women who don’t already have diabetes.

Gestational diabetes is affecting around 1 in 7 pregnancies worldwide, and can be associated with adverse outcomes for both mothers and babies.

Causes:

1. Gestational diabetes occurs when your body can’t make enough insulin during your pregnancy. Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into the cells in your body for use as energy.
2. During pregnancy, your body makes more hormones and goes through other changes, such as weight gain. These changes cause your body’s cells to use insulin less effectively, a condition called insulin resistance. Insulin resistance increases your body’s need for insulin.
3. All pregnant women have some insulin resistance during late pregnancy. However, some women have insulin resistance even before they get pregnant. They start pregnancy with an increased need for insulin and are more likely to have gestational diabetes.

Complications:

1. Having gestational diabetes can increase your risk of high blood pressure during pregnancy. It can also increase your risk of having a large baby that needs to be delivered by cesarean section (C-section).
2. GDM poses significant risks to the immediate and long-term health of the mother and fetus.
3. For the fetus, a key risk is accelerated intrauterine growth, resulting in macrosomic or large for gestational age (LGA) neonates.
4. At delivery, macrosomic and LGA neonates are at significantly elevated risk of adverse perinatal outcomes, including shoulder dystocia, birth trauma, neonatal hypoglycaemia, and admission to neonatal intensive care.
5. Hence it is essential to implement effective clinical interventions to maintain glycaemic control and limit fetal growth to within normal parameters during GDM-affected pregnancies.

Gestational diabetes usually goes away after your baby is born. However, about 50% of women with gestational diabetes go on to develop type 2 diabetes. You can lower your risk by reaching a healthy body weight after delivery. Visit your doctor to have your blood sugar tested 6 to 12 weeks after your baby is born and then every 1 to 3 years to make sure your levels are on target.

Treatment: 

There are several effective treatment strategies available for gestational diabetes, including using metformin or insulin to control high blood sugars in the mother.

Effects of Metformin on growth of the baby:

Metformin is increasingly offered as an acceptable and economic alternative to insulin for treatment of gestational diabetes mellitus (GDM) in many countries. However, the impact of maternal metformin treatment on the trajectory of fetal, infant, and childhood growth is unknown.

A study was conducted to fully understand the effects that these 2 treatment options may have on the growth of the baby in the womb and also after birth into childhood.

The researchers found that neonates exposed to metformin in utero weighed less at birth than neonates whose mothers were exposed to insulin, in the context of treatment for GDM. 

Despite being born at lower average birth weights, by the age of 2 years, metformin-exposed infants were heavier than infants whose mothers were treated with insulin. In mid-childhood (5–9 years), the absolute weight difference between groups did not reach statistical significance, but children exposed to metformin in utero had higher BMI than those whose mothers were treated with insulin.

The children who are born small and then undergo ‘catch-up growth’ after birth are at increased risk of developing cardiovascular disease and type 2 diabetes later in life.

Source: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002848