Add on metformin to insulin may not lower preeclampsia risk among parturients with gestational or pre-existing type 2 diabetes: Study

A new study published in the journal of Obstetrics and Gynaecology has found that Addition of metformin to insulin was not associated with lower odds of preterm preeclampsia among parturients with early gestational or pre-existing type 2 diabetes.

Gestational diabetes mellitus (GDM) is a common prenatal endocrine disease that can cause short- and long-term health concerns for women and their fetuses. Due to its rising prevalence and correlation with numerous adverse maternal-fetal outcomes, including pre-eclampsia and eclampsia, caesarean section, preterm delivery, neonatal hypoglycemia, macrosomia and neonatal respiratory distress syndrome. Along with an increased risk of type 2 diabetes (T2D), obesity, and cardiovascular disease after gestation, the World Health Organisation designated GDM as a "global health research priority" in 2018. Consequently, Maya Patel and colleagues carried out this investigation to calculate the correlation between the usage of metformin by mothers to treat early gestational diabetes or preterm preeclampsia and pre-existing type 2 diabetes.

The MOMPOD study compared the impact of insulin treatment plus metformin on composite neonatal outcome in singleton pregnancies with early gestational or type 2 diabetes. At 11 to 23 weeks gestation, the participants were randomized to receive a placebo or 1,000 mg of metformin twice a day until birth. Serum levels of various components were measured in a subgroup of participants whose maternal blood was drawn between 24 and 30 weeks of gestation. Preterm preeclampsia, or preeclampsia necessitating delivery before 37 weeks of gestation was the primary outcome. Serum biomarker variations and preterm preeclampsia necessitating delivery before 34 weeks of gestation were secondary outcomes.

The study found that 57 of 416 (13.7%) and 62 of 415 (14.9%) of the 831 participants experienced preeclampsia which necessitated delivery before 37 weeks of gestation. These 119 individuals (or 14.3% of the total) who took metformin experienced this condition. 37 (4.4%) women received metformin (22,5.3%) and 15 (3.6%) received a placebo as treatment for preeclampsia, which required delivery before 34 weeks of gestation. Metformin did not significantly alter the risk of preeclampsia occurring before 37 weeks or before 34 weeks of gestation when compared to placebo. Likewise, no correlation was seen between the levels of blood biomarkers and the usage of metformin by mothers.

Overall, adding metformin to insulin was not related with a decreased incidence of preterm preeclampsia or serum biomarkers associated with CVD risk in pregnant women with early gestational or pre-existing type 2 diabetes.

Source:

Patel, M., Battarbee, A. N., Refuerzo, J. S., Zork, N., Eichelberger, K., Ramos, G. A., Olson, G., Durnwald, C., Landon, M. B., Aagaard, K. M., Wallace, K., Scifres, C., Rosen, T., Mulla, W., Valent, A., Longo, S., & Boggess, K. A. (2024). Association Between Metformin Use in Early Gestational or Type 2 Diabetes in Pregnancy and Preterm Preeclampsia. In Obstetrics & Gynecology. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/aog.0000000000005720