Lights and shadows on the use of metformin in pregnancy: from the preconception phase to breastfeeding and beyond

Frontiers in Endocrinology

Endocrinology

Alfredo Pontecorvi¹  Antonio Lanzone²  Angelo Sirico²  Sara De Carolis²  Linda Tartaglione³  Annarita Barberio³  Mauro Di Leo³  Luca Viti³  Dario Pitocco³  Giulia Tosti³  Alessandro Rizzi³ 

[1] Catholic University School of Medicine, Rome, Italy;Department of Endocrinology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy;Catholic University School of Medicine, Rome, Italy;Department of Woman and Child Health, Woman Health Area Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy;Diabetes Care Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy;Catholic University School of Medicine, Rome, Italy;

关键词: gestational diabetes;    insulin resistance;    pregnancy;    metformin;    offspring;    fertilization;   

DOI  :  10.3389/fendo.2023.1176623

 received in 2023-02-28, accepted in 2023-05-17,  发布年份 2023

来源: Frontiers

【 摘 要 】

During pregnancy, the complex hormonal changes lead to a progressive decrease of insulin sensitivity that can drive the onset of gestational diabetes (GDM) or worsen an already-known condition of insulin resistance like type 2 diabetes, polycystic ovarian syndrome (PCOS), and obesity, with complications for the mother and the fetus. Metformin during pregnancy is proving to be safe in a growing number of studies, although it freely crosses the placenta, leading to a fetal level similar to maternal concentration. The aim of this literature review is to analyze the main available evidence on the use of metformin during, throughout, and beyond pregnancy, including fertilization, lactation, and medium-term effects on offspring. Analyzed studies support the safety and efficacy of metformin during pregnancy. In pregnant women with GDM and type 2 diabetes, metformin improves obstetric and perinatal outcomes. There is no evidence that it prevents GDM in women with pregestational insulin resistance or improves lipid profile and risk of GDM in pregnant women with PCOS or obesity. Metformin could have a role in reducing the risk of preeclampsia in pregnant women with severe obesity, the risk of late miscarriages and preterm delivery in women with PCOS, and the risk of ovarian hyperstimulation syndrome, increasing the clinical pregnancy rate in women with PCOS undergoing in vitro fertilization (IVF/FIVET). Offspring of mothers with GDM exposed to metformin have no significant differences in body composition compared with insulin treatment, while it appears to be protective for metabolic and cardiovascular risk.

【 授权许可】

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Copyright © 2023 Tosti, Barberio, Tartaglione, Rizzi, Di Leo, Viti, Sirico, De Carolis, Pontecorvi, Lanzone and Pitocco