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Metformin fails to improve birth outcomes in pregnancy with obesity
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Among pregnant women with obesity, the use of metformin in addition to diet and lifestyle did not affect birth outcomes when compared with similar women who received placebo along with diet and lifestyle, according to findings from a randomized controlled trial in Australia.
“While metformin in addition to dietary advice reduced weekly pregnancy weight gain, it did not impact clinical pregnancy and birth outcomes,” Jodie Dodd, MD, PhD, professor in obstetrics and gynecology at the University of Adelaide and maternal fetal medicine specialist at Women’s and Children’s Hospital in North Adelaide, Australia, told Endocrine Today. “Metformin from early pregnancy for women who are overweight or obese is not recommended.”
Dodd and colleagues analyzed data from 514 pregnant women with overweight or obesity recruited from the major public maternity hospitals in metropolitan Adelaide for the GRoW study, a randomized, double-blind, placebo-controlled trial (median gestational age at baseline, 16.29 weeks; median BMI, 32.32 kg/m²). Between May 2013 and April 2016, researchers randomly assigned women to metformin (to a maximum dose of 200 mg per day; n = 261) or matching placebo (n = 263); all women received antenatal dietary and lifestyle interventions. Primary outcome was the proportion of infants with a birth weight greater than 4,000 g. Secondary outcomes included maternal weight gain, maternal diet and physical activity, maternal pregnancy and birth outcomes, maternal quality of life and emotional well-being, and infant birth outcomes.
Within the cohort, 32% of women had overweight and 68% had obesity.
When comparing women who did and did not receive metformin therapy, researchers did not observe a between-group difference in the proportion of infants with a birth weight greater than 4,000 g (16% vs. 14%; P = .899). Women assigned to metformin experienced a lower average weekly gestational weight gain (adjusted mean difference, –0.08 kg; P = .007) and were more likely to have gestational weight gain below recommendations (adjusted RR = 1.46; 95% CI, 1.1-1.94). There were no between-group differences for total gestational weight gain, pregnancy and birth outcomes, maternal diet and physical activity, maternal quality of life and emotional well-being.
In a post hoc analysis incorporating the findings into a previously reported Cochrane systematic review, researchers found that metformin was associated with only a modest effect on gestational weight gain in pregnant women with overweight or obesity (mean difference, –2.27 kg; 95% CI, –4.45 to –0.08). Additionally, there was no effect on birth weight or the risk for preeclampsia, according to the researchers.
“Overall, dietary interventions have not been effective in improving pregnancy outcomes; metformin, alone or combined with dietary advice, is not effective in improving pregnancy outcomes,” Dodd said. “Our focus needs to change to evaluating whether helping women achieve weight loss before they conceive is an effective strategy to improve pregnancy outcomes.” – by Regina Schaffer
For more information:
Jodie M. Dodd, MD, PhD, can be reached at Women’s and Children’s Hospital, Discipline of Obstetrics & Gynaecology, 72 King William Road, North Adelaide, South Australia, Australia, 5006; email: Jodie.dodd@adelaide.edu.au.
Disclosures: The authors report no relevant financial disclosures.
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