The Effect of Metformin in Gestational Diabetes
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy . It is observed in 7–18% of pregnancies and is associated with an increased risk of a variety of maternal and perinatal complications, including preeclampsia, Caesarean section, shoulder dystocia, birth injuries, hypoglycaemia and respiratory distress syndrome (RDS) . 4 Metformin is an anti-hyperglycaemic agent reduces hyperglycaemia by suppressing hepatic glucose output (hepatic gluconeogenesis), increasing insulin sensitivity and enhancing peripheral glucose uptake. Implementation of metformin should be in conjunction with diet and exercise for glycemic control. The U.S. Food and Drug Administration categorizes this medication as a class B drug in pregnancy; however, it cautions that metformin can cross the placenta and should not be used during pregnancy unless clearly needed. Despite these concerns, metformin appears to be an alternative option for the treatment of GDM
Gestational diabetes is glucose intolerance identified in the second trimester of pregnancy. This occurs mainly due to the diabetogenic effects of placental hormones and is associated with certain critical fetal and maternal consequences. 1 If maternal normoglycaemia cannot be achieved by diet and lifestyle changes, medication will be needed. The standard treatment for achieving adequate glucose levels is insulin therapy. However, the disadvantages of insulin for the mother include the need for injections, risk of hypoglycaemia, increased appetite and weight gain. Furthermore, this treatment requires modification based on the patient's body mass index, glucose levels and lifestyle . 2 Metformin appears to be a viable option for use in GDM. This medication with a different mode of action from insulin is an antihyperglycemic agent Its primary mechanism of action is in reducing hepatic glucose production. Secondarily, it decreases intestinal absorption of glucose and improves insulin sensitivity by increasing peripheral glucose uptake and utilization and does not cause either hypoglycemia or hyperinsulinemia.