Maple-Brown, Louise

Lindenmayer, Greta

Barzi F

Whitbread, Cherie

Connors, Christine

Moore E

Boyle JA

Kirkwood M

Lee IL

Longmore D

van Dokkum P

Wicks, Mary

Dowden M

Inglis C

Cotter M

Kirkham R

Corpus, Sumaria

Chitturi S

Thomas, Sujatha

O'Dea K

Zimmet P

Oats J

McIntyre HD

Brown A

Shaw JE

2019-09-01

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.

Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.

Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.

Northern Territory Department of Health, Darwin, Northern Territory, Australia.

Aboriginal Medical Services Alliance Northern Territory, Darwin, Northern Territory, Australia.

Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.

Population Health Research, Baker Heart and Diabetes Institute, Alice Springs, Northern Territory, Australia.

One Disease, Darwin, Northern Territory, Australia.

Healthy Living NT, Darwin, Northern Territory, Australia.

Danila Dilba Health Service, Darwin, Northern Territory, Australia.

Obstetrics and Gynaecology Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia.

Population Health Research, University of South Australia, Adelaide, South Australia, Australia.

Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia.

Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.

Mater Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia.

South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.

Population Health Research, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.

J Diabetes . 2019 Sep;11(9):761-770. doi: 10.1111/1753-0407.12905. Epub 2019 Feb 19.

https://pubmed.ncbi.nlm.nih.gov/30680949/?otool=iaurydwlib

https://hdl.handle.net/10137/8388

11

Adult

Australia/epidemiology

Biomarkers/*blood

Birth Weight

Blood Glucose/metabolism

Case-Control Studies

Diabetes Mellitus, Type 2/blood/*drug therapy/epidemiology

Diabetes, Gestational/blood/*drug therapy/epidemiology

Female

Follow-Up Studies

Gestational Age

Humans

Hypoglycemic Agents/*therapeutic use

Metformin/*therapeutic use

Northern Territory

Population Groups

Prediabetic State/blood/*drug therapy/epidemiology

Pregnancy

Pregnancy Outcome

Prognosis

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

Journal Article

Publication