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Title: A real-world experience of metformin use in pregnancy: observational data from the Northern Territory Diabetes in Pregnancy Clinical Register.
Authors: Maple-Brown, Louise J
Lindenmayer, Greta
Barzi, Federica
Whitbread, Cherie
Connors, Christine
Moore, Elizabeth
Boyle, Jaqueline
Kirkwood, Marie
Lee, I-Lynn
Longmore, Danielle
Van Dokkum, Paula
Wicks, Mary
Dowden, Michelle
Inglis, Chrissie
Cotter, Margaret
Kirkham, Renae
Corpus, Sumaria
Chitturi, Sridhar
Thomas, Sujatha
O'dea, Kerin
Zimmet, Paul
Oats, Jeremy
McIntyre, Harold D
Brown, Alex
Shaw, Jonathan E
Citation: Journal of diabetes 2019-01-25
Abstract: In Australia's Northern Territory, Indigenous mothers account for 33% of births and have high rates of hyperglycaemia in pregnancy. Prevalence of type 2 diabetes in pregnancy is up to 10 times 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. Women with gestational diabetes (GDM), newly diagnosed diabetes in pregnancy (DIP), or pre-existing type 2 diabetes (T2DM) from 2012 to 2016 were included. Data were analysed for metformin use in the third trimester. Regression models were adjusted for maternal age, body mass index, parity and insulin use. Of 1649 pregnancies, 814 (49.4%) were to Indigenous women, of whom 234 (28.7%) had T2DM (vs 4.6% non-Indigenous women, p<0.001). Metformin use was high in Indigenous women (84-90% T2DM, 42-48% GDM/DIP) and increased over time in non-Indigenous women (43-100% T2DM, 14-35% GDM/DIP). There were no significant differences between groups with and without metformin for caesarean section [among Indigenous women with GDM/DIP with vs without metformin 51% vs 39%, adjusted OR(95% CI), 1.25(0.87, 1.81), p=0.22], large-for-gestational-age [24% vs 13%, adjusted OR, 1.5 (0.9, 2.5), p=0.1] or serious neonatal adverse events [9.4% vs 5.9%, adjusted OR, 1.32 (0.68, 2.57), p=0.42]. Metformin use was independently associated with earlier gestational age (37.7 weeks vs 38.5 weeks), however 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 [OR 1.68 (0.97, 2.92), p=0.61]. We found no clear evidence of any adverse outcomes related to the use of metformin for the treatment of hyperglycaemia in pregnancy.
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Journal title: Journal of diabetes
Publication Date: 2019-01-25
Type: Journal Article
DOI: 10.1111/1753-0407.12905
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