Real-world experience of metformin use in pregnancy

Observational data from the Northern Territory Diabetes in Pregnancy Clinical Register

Louise J. Maple-Brown, on behalf of the Northern Territory Diabetes in Pregnancy Partnership

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: In Australia's Northern Territory, Indigenous mothers account for 33% of births and have high rates of hyperglycemia in pregnancy. The prevalence of type 2 diabetes (T2D) in pregnancy is up to 10-fold higher in Indigenous than non-Indigenous Australian mothers, and the use of metformin is common. We assessed birth outcomes in relation to metformin use during pregnancy from a clinical register. Methods: The study included women with gestational diabetes (GDM), newly diagnosed diabetes in pregnancy (DIP), or pre-existing T2D from 2012 to 2016. Data were analyzed for metformin use in the third trimester. Regression models were adjusted for maternal age, body mass index, parity, and insulin use. Results: Of 1649 pregnancies, 814 (49.4%) were to Indigenous women, of whom 234 (28.7%) had T2D (vs 4.6% non-Indigenous women; P < 0.001). Metformin use was high in Indigenous women (84%-90% T2D, 42%-48% GDM/DIP) and increased over time in non-Indigenous women (43%-100% T2D, 14%-35% GDM/DIP). Among Indigenous women with GDM/DIP, there were no significant differences between groups with and without metformin in cesarean section (51% vs 39%; adjusted odds ratio [aOR] 1.25, 95% confidence interval [CI] 0.87-1.81), large for gestational age (24% vs 13%; aOR 1.5, 95% CI 0.9-2.5), or serious neonatal adverse events (9.4% vs 5.9%; aOR 1.32, 95% CI 0.68-2.57). Metformin use was independently associated with earlier gestational age (37.7 vs 38.5 weeks), but the risk did not remain independently higher after exclusion of women managed with medical nutrition therapy alone, and the increase in births <37 weeks was not significant on multivariate analysis. Conclusions: We found no clear evidence of any adverse outcomes related to the use of metformin for the treatment of hyperglycemia in pregnancy.

Original languageEnglish
JournalJournal of Diabetes
DOIs
Publication statusAccepted/In press - 25 Jan 2019

Keywords

  • birth outcomes
  • diabetes in pregnancy
  • gestational diabetes
  • metformin
  • type 2 diabetes in pregnancy

Cite this

Maple-Brown, Louise J. ; on behalf of the Northern Territory Diabetes in Pregnancy Partnership. / Real-world experience of metformin use in pregnancy : Observational data from the Northern Territory Diabetes in Pregnancy Clinical Register. In: Journal of Diabetes. 2019.
@article{de481323ece84c2bad4e536251510bb5,
title = "Real-world experience of metformin use in pregnancy: Observational data from the Northern Territory Diabetes in Pregnancy Clinical Register",
abstract = "Background: In Australia's Northern Territory, Indigenous mothers account for 33{\%} of births and have high rates of hyperglycemia in pregnancy. The prevalence of type 2 diabetes (T2D) in pregnancy is up to 10-fold higher in Indigenous than non-Indigenous Australian mothers, and the use of metformin is common. We assessed birth outcomes in relation to metformin use during pregnancy from a clinical register. Methods: The study included women with gestational diabetes (GDM), newly diagnosed diabetes in pregnancy (DIP), or pre-existing T2D from 2012 to 2016. Data were analyzed for metformin use in the third trimester. Regression models were adjusted for maternal age, body mass index, parity, and insulin use. Results: Of 1649 pregnancies, 814 (49.4{\%}) were to Indigenous women, of whom 234 (28.7{\%}) had T2D (vs 4.6{\%} non-Indigenous women; P < 0.001). Metformin use was high in Indigenous women (84{\%}-90{\%} T2D, 42{\%}-48{\%} GDM/DIP) and increased over time in non-Indigenous women (43{\%}-100{\%} T2D, 14{\%}-35{\%} GDM/DIP). Among Indigenous women with GDM/DIP, there were no significant differences between groups with and without metformin in cesarean section (51{\%} vs 39{\%}; adjusted odds ratio [aOR] 1.25, 95{\%} confidence interval [CI] 0.87-1.81), large for gestational age (24{\%} vs 13{\%}; aOR 1.5, 95{\%} CI 0.9-2.5), or serious neonatal adverse events (9.4{\%} vs 5.9{\%}; aOR 1.32, 95{\%} CI 0.68-2.57). Metformin use was independently associated with earlier gestational age (37.7 vs 38.5 weeks), but the risk did not remain independently higher after exclusion of women managed with medical nutrition therapy alone, and the increase in births <37 weeks was not significant on multivariate analysis. Conclusions: We found no clear evidence of any adverse outcomes related to the use of metformin for the treatment of hyperglycemia in pregnancy.",
keywords = "birth outcomes, diabetes in pregnancy, gestational diabetes, metformin, type 2 diabetes in pregnancy",
author = "Maple-Brown, {Louise J.} and Greta Lindenmayer and Federica Barzi and Cherie Whitbread and Christine Connors and Elizabeth Moore and Jacqueline Boyle and Marie Kirkwood and Lee, {I. Lynn} and Danielle Longmore and {van Dokkum}, Paula and Mary Wicks and Michelle Dowden and Chrissie Inglis and Margaret Cotter and Renae Kirkham and Sumaria Corpus and Sridhar Chitturi and Sujatha Thomas and Kerin O'Dea and Paul Zimmet and Jeremy Oats and McIntyre, {Harold D.} and Alex Brown and Shaw, {Jonathan E.} and {on behalf of the Northern Territory Diabetes in Pregnancy Partnership}",
year = "2019",
month = "1",
day = "25",
doi = "10.1111/1753-0407.12905",
language = "English",
journal = "Journal of Diabetes",
issn = "1753-0393",
publisher = "Wiley-Blackwell",

}

Real-world experience of metformin use in pregnancy : Observational data from the Northern Territory Diabetes in Pregnancy Clinical Register. / Maple-Brown, Louise J.; on behalf of the Northern Territory Diabetes in Pregnancy Partnership.

In: Journal of Diabetes, 25.01.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Real-world experience of metformin use in pregnancy

T2 - Observational data from the Northern Territory Diabetes in Pregnancy Clinical Register

AU - Maple-Brown, Louise J.

AU - Lindenmayer, Greta

AU - Barzi, Federica

AU - Whitbread, Cherie

AU - Connors, Christine

AU - Moore, Elizabeth

AU - Boyle, Jacqueline

AU - Kirkwood, Marie

AU - Lee, I. Lynn

AU - Longmore, Danielle

AU - van Dokkum, Paula

AU - Wicks, Mary

AU - Dowden, Michelle

AU - Inglis, Chrissie

AU - Cotter, Margaret

AU - Kirkham, Renae

AU - Corpus, Sumaria

AU - Chitturi, Sridhar

AU - Thomas, Sujatha

AU - O'Dea, Kerin

AU - Zimmet, Paul

AU - Oats, Jeremy

AU - McIntyre, Harold D.

AU - Brown, Alex

AU - Shaw, Jonathan E.

AU - on behalf of the Northern Territory Diabetes in Pregnancy Partnership

PY - 2019/1/25

Y1 - 2019/1/25

N2 - Background: In Australia's Northern Territory, Indigenous mothers account for 33% of births and have high rates of hyperglycemia in pregnancy. The prevalence of type 2 diabetes (T2D) in pregnancy is up to 10-fold higher in Indigenous than non-Indigenous Australian mothers, and the use of metformin is common. We assessed birth outcomes in relation to metformin use during pregnancy from a clinical register. Methods: The study included women with gestational diabetes (GDM), newly diagnosed diabetes in pregnancy (DIP), or pre-existing T2D from 2012 to 2016. Data were analyzed for metformin use in the third trimester. Regression models were adjusted for maternal age, body mass index, parity, and insulin use. Results: Of 1649 pregnancies, 814 (49.4%) were to Indigenous women, of whom 234 (28.7%) had T2D (vs 4.6% non-Indigenous women; P < 0.001). Metformin use was high in Indigenous women (84%-90% T2D, 42%-48% GDM/DIP) and increased over time in non-Indigenous women (43%-100% T2D, 14%-35% GDM/DIP). Among Indigenous women with GDM/DIP, there were no significant differences between groups with and without metformin in cesarean section (51% vs 39%; adjusted odds ratio [aOR] 1.25, 95% confidence interval [CI] 0.87-1.81), large for gestational age (24% vs 13%; aOR 1.5, 95% CI 0.9-2.5), or serious neonatal adverse events (9.4% vs 5.9%; aOR 1.32, 95% CI 0.68-2.57). Metformin use was independently associated with earlier gestational age (37.7 vs 38.5 weeks), but the risk did not remain independently higher after exclusion of women managed with medical nutrition therapy alone, and the increase in births <37 weeks was not significant on multivariate analysis. Conclusions: We found no clear evidence of any adverse outcomes related to the use of metformin for the treatment of hyperglycemia in pregnancy.

AB - Background: In Australia's Northern Territory, Indigenous mothers account for 33% of births and have high rates of hyperglycemia in pregnancy. The prevalence of type 2 diabetes (T2D) in pregnancy is up to 10-fold higher in Indigenous than non-Indigenous Australian mothers, and the use of metformin is common. We assessed birth outcomes in relation to metformin use during pregnancy from a clinical register. Methods: The study included women with gestational diabetes (GDM), newly diagnosed diabetes in pregnancy (DIP), or pre-existing T2D from 2012 to 2016. Data were analyzed for metformin use in the third trimester. Regression models were adjusted for maternal age, body mass index, parity, and insulin use. Results: Of 1649 pregnancies, 814 (49.4%) were to Indigenous women, of whom 234 (28.7%) had T2D (vs 4.6% non-Indigenous women; P < 0.001). Metformin use was high in Indigenous women (84%-90% T2D, 42%-48% GDM/DIP) and increased over time in non-Indigenous women (43%-100% T2D, 14%-35% GDM/DIP). Among Indigenous women with GDM/DIP, there were no significant differences between groups with and without metformin in cesarean section (51% vs 39%; adjusted odds ratio [aOR] 1.25, 95% confidence interval [CI] 0.87-1.81), large for gestational age (24% vs 13%; aOR 1.5, 95% CI 0.9-2.5), or serious neonatal adverse events (9.4% vs 5.9%; aOR 1.32, 95% CI 0.68-2.57). Metformin use was independently associated with earlier gestational age (37.7 vs 38.5 weeks), but the risk did not remain independently higher after exclusion of women managed with medical nutrition therapy alone, and the increase in births <37 weeks was not significant on multivariate analysis. Conclusions: We found no clear evidence of any adverse outcomes related to the use of metformin for the treatment of hyperglycemia in pregnancy.

KW - birth outcomes

KW - diabetes in pregnancy

KW - gestational diabetes

KW - metformin

KW - type 2 diabetes in pregnancy

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U2 - 10.1111/1753-0407.12905

DO - 10.1111/1753-0407.12905

M3 - Article

JO - Journal of Diabetes

JF - Journal of Diabetes

SN - 1753-0393

ER -