Long-term effects of metformin use in gestational diabetes mellitus on offspring health

Abstract

Metformin is the first-line drug for the treatment of type 2 diabetes mellitus, but its role in gestational diabetes mellitus (GDM) management is not clear. Recent evidence suggests a certain beneficial effect of metformin in the treatment of GDM, but a high treatment failure rate leads to the initiation of additional medications, such as insulin. Moreover, since metformin crosses the placental barrier and reaches a significant level in the fetus, it is likely to influence the fetal metabolic milieu. The evidence indicates the long-term safety in children exposed to metformin in utero except for mild adverse anthropometric profiles. Diligent follow-up of metformin-exposed offspring is warranted from the clinician’s point of view.

Keywords: Anthropometry; Fetal; Gestational diabetes mellitus; Long-term; Metformin; Offspring

Core Tip: The use of metformin in mild-to-moderate gestational diabetes mellitus may confer certain advantages. Since metformin reaches almost a similar serum level in the fetus, it is likely to influence the fetal metabolic environment. Limited long-term data suggest that metformin-exposed children have mild adverse anthropometric profiles. However, the clinical significance and effect on cardiometabolic health have yet to be determined.