title: The emerging role of metformin in gestational diabetes mellitus.
abstract: Metformin use during pregnancy is controversial and there is disparity in the acceptance of metformin treatment in women with gestational diabetes mellitus (GDM) in Australia. Despite short term maternal and neonatal safety measures, the placental transfer of metformin during GDM treatment and the absence of long-term safety data in offspring has regulators and prescribers cautious about its use. To determine the current role in GDM management, this literature review describes the physiological changes that occur in GDM and other forms of diabetes in pregnancy (DIP) and international changes in guidelines for GDM diagnosis. Management options are considered, with a focus on the evolving evidence for metformin, its mechanism of action, the maternal, foetal and neonatal outcomes associated with its use and benefit vs risk when compared with the current gold standard, insulin. Investigation reveals a favourable balance of evidence to support the safety and long-term benefits, to mother and child, of using metformin as an alternate to insulin for treatment of GDM. Recent findings of the gastrointestinal-directed action of metformin are at least as important as the hepatic effect and the availability of a novel delayed-release metformin dose form to exploit this new information provides a product and therapeutic strategy ideally suited to the use of metformin in GDM.
authors.affiliation: School of Pharmacy, The University of Queensland, Brisbane, Australia.
authors.forename: Susan G
authors.initials: SG
authors.lastname: Gray
authors.affiliation: School of Pharmacy, The University of Queensland, Brisbane, Australia.|Mater Pharmacy Services, Mater Health Services, Brisbane, Australia.|Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
authors.forename: Treasure M
authors.initials: TM
authors.lastname: McGuire
authors.affiliation: Diabetes Clinics, BakerIDI Heart and Diabetes Institute, Prahran, Australia.
authors.forename: Neale
authors.initials: N
authors.lastname: Cohen
authors.affiliation: School of Pharmacy, The University of Queensland, Brisbane, Australia.|Department of Pharmacy, Xinhua College of Sun Yat-sen University, Guangzhou, China.
authors.forename: Peter J
authors.identifier: 0000-0002-0335-3835
authors.initials: PJ
authors.lastname: Little
mesh_terms: D001315:Australia; D016640:Diabetes, Gestational / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007328:Insulin / Q000627:therapeutic use; D008687:Metformin / Q000009:adverse effects*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000188:drug therapy* / Q000503:physiopathology; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin
keywords: diabetes in pregnancy; gestational diabetes mellitus; insulin; metformin; pharmacology; therapeutics