Recent findings presented at the Endocrine Society’s ENDO 24 annual meeting suggest that metformin may be a safe alternative to insulin for treating type 2 diabetes during pregnancy.
The study, yet to be published in a peer-reviewed journal, monitored health data and potential long-term effects of metformin use during pregnancy for up to 11 years postpartum.
Maintaining optimal blood glucose levels during pregnancy is pivotal for fetal development and maternal well-being. While medications like GLP-1 analogs such as Ozempic are not approved for pregnancy, both metformin and insulin have been utilized for decades in pregnant individuals with diabetes.
Metformin, a widely prescribed medication for type 2 diabetes, has been considered safe during pregnancy due to its minimal risk of hypoglycemia. However, previous research on its long-term effects on offspring has been limited to approximately five years postpartum.
Comparing Metformin and Insulin Use
Researchers from the Center for Endocrinology, Diabetes, Arthritis & Rheumatism in New Delhi, India, analyzed data from 10,117 mother-child pairs to assess the long-term health outcomes associated with metformin versus insulin use during pregnancy for managing type 2 diabetes.
Their analysis encompassed various health parameters, including body mass index (BMI), waist circumference, total body fat percentage, liver fat percentage, and rates of obesity and diabetes in both mothers and children.
The study found no significant increase in adverse health outcomes in children born to mothers who used metformin compared to those who used insulin during pregnancy.
Implications and Considerations
The study underscores the importance of expanding treatment options for managing diabetes during pregnancy. While insulin has traditionally been the primary choice due to its inability to cross the placenta, metformin presents a simpler alternative, administered in pill form rather than through injections.
Jennifer Smith, RD, CDCES, emphasizes the nuanced approach required in selecting appropriate treatment, considering factors beyond the diabetes diagnosis. Metformin may serve as an initial option, particularly for individuals who have made lifestyle modifications in diet and exercise, but insulin remains crucial in cases where metformin alone is insufficient to achieve optimal blood glucose levels.
Smith highlights the complementary roles of insulin and metformin, with insulin aiding glucose utilization by cells and metformin primarily regulating liver glucose production and enhancing insulin sensitivity. Combining these medications can significantly improve blood glucose management during pregnancy, ensuring the well-being of both mother and child.
While metformin emerges as a promising option, Smith cautions against abrupt changes in medication regimens, particularly for individuals already using insulin before conception. Each woman’s journey is unique, necessitating personalized treatment approaches tailored to individual needs and medical histories.
Managing diabetes during pregnancy requires dedication and vigilance, yet with appropriate medical guidance and support, women can navigate this journey effectively, safeguarding their health and that of their offspring.
