Real-world experience of metformin use in pregnancy

Observational data from the Northern Territory Diabetes in Pregnancy Clinical Register

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
    Pages (from-to)761-770
    Number of pages10
    JournalJournal of Diabetes
    Volume11
    Issue number9
    Early online date25 Jan 2019
    DOIs
    Publication statusPublished - Sep 2019

    Fingerprint

    Northern Territory
    Pregnancy in Diabetics
    Metformin
    Type 2 Diabetes Mellitus
    Pregnancy
    Odds Ratio
    Parturition
    Confidence Intervals
    Hyperglycemia
    Gestational Age
    Mothers
    Nutrition Therapy
    Gestational Diabetes
    Maternal Age
    Third Pregnancy Trimester
    Parity
    Cesarean Section
    Body Mass Index
    Multivariate Analysis
    Insulin

    Cite this

    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 ; Vol. 11, No. 9. pp. 761-770.
    @article{cf8b07195085401886c0c5f2b5aa3c65,
    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 = "9",
    doi = "10.1111/1753-0407.12905",
    language = "English",
    volume = "11",
    pages = "761--770",
    journal = "Journal of Diabetes",
    issn = "1753-0407",
    publisher = "Wiley Publishing Asia Pty Ltd",
    number = "9",

    }

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

    In: Journal of Diabetes, Vol. 11, No. 9, 09.2019, p. 761-770.

    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 - 2019/9

    Y1 - 2019/9

    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

    UR - http://www.scopus.com/inward/record.url?scp=85061925627&partnerID=8YFLogxK

    U2 - 10.1111/1753-0407.12905

    DO - 10.1111/1753-0407.12905

    M3 - Article

    VL - 11

    SP - 761

    EP - 770

    JO - Journal of Diabetes

    JF - Journal of Diabetes

    SN - 1753-0407

    IS - 9

    ER -