gestational diabetes mellitus.

The best possible management of these patients to achieve optimal

glucose control and consistently good neonatal outcomes is not yet
established Although insulin therapy is highly effective, it has the
disadvantages of needing to be given by injection and causing weight gain.
Furthermore, insulin does not address the fundamental problem in these
patients which is insulin resistance. For this reason, very large doses of insulin
are often required. A safe and effective oral agent would be welcomed by
patients and their healthcare professionals. (thus metformin enters)

Why metformin

Metformin improves insulin sensitivity and would be expected therefore

to improve glucose tolerance in pregnancy by reducing the physiological rise
in insulin resistance that occurs during pregnancy. Indeed clinical studies show
a reduction in insulin resistance as assessed by HOMA of 46% when
metformin is started before conception and continued during pregnancy.

Metformin is widely used outside of pregnancy for type 2 diabetes as it

has a low risk of causing hypoglycaemia and is not associated with weight
gain. Metformin offers the advantage of being in a tablet form and is usually
well tolerated.

Metformin

Metformin doses ranging from 500 to 2500 mg/day have been used to

treat women with GDM and the impact of doses exceeding 2500 mg/day on
maternal, fetal and neonatal safety has not been determined. Starting on a
low dose (just 1 tablet) and increasing the dose slowly will reduce these side
effects.

(Metformin has been tested in clinical studies and is safe to take

for gestational diabetes. Metformin helps keep both your weight gain and
blood pressure down. The main side effect is stomach upsets such as
feeling sick and diarrhoea.)

Management
 The main goal of diabetes treatment is to normalize insulin activity and blood
glucose levels to reduce the development of vascular and neuropathic complications.