K Swaminathan, HCS Howlett, IW Campbell



An ever-increasing number of women with Type 2 diabetes mellitus (DM) are going through pregnancy and, with the current epidemic of obesity, more women are being diagnosed with gestational diabetes mellitus (GDM). Insulin has traditionally been the gold standard in diabetic pregnancy because of its efficacy and the fact that it does not cross the placenta. However, recent data from welldesigned trials and meta-analysis on the use of oral agents inĀ  gestational diabetes may mark a significant shift in clinical practice. Evidence for metformin use in GDM has been enhanced by the MiG trial, but a randomised controlled trial in women with Type 2 DM in pregnancy is required. No long-term follow-up data for offspring of mothers receiving metformin have been published, apart from reassuring findings in one study with an 18-month follow-up period. The aim of this article is to review the safety, efficacy and future of metformin in diabetic pregnancy.

Keywords Diabetes, metformin, pregnancy

Declaration of Interests Dr Swaminathan has received honoraria for lecturing and support to attend medicalĀ  meetings from Eli Lily, MSD and Takeda. Prof. Campbell has received similar support from AstraZeneca, MSD, Merck Serono, Novo Nordisk, Novartis, Sanofi-Aventis and Takeda. Dr Howlett retired from his position as Senior International Medical Adviser with Merck Serono in August 2008.

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