Metformin in diabetic pregnancy

An  ever-increasing  number  of  women  with Type  2  diabetes  mellitus (DM) are going through pregnancy and, with the current epidemic of obesity, more women are being diagnosed with gestational diabetes mellitus (GDM). Insulin has traditionally been the gold standard in diabetic pregnancy because of its efficacy and the  fact  that  it  does  not  cross  the  placenta.  However,  recent  data  from  well-designed trials and meta-analysis on the use of oral agents in gestational diabetes may mark a significant shift in clinical practice. Evidence for metformin use in GDM has been enhanced by the MiG trial, but a randomised controlled trial in women with Type 2 DM in pregnancy is required. No long-term follow-up data for offspring of  mothers  receiving  metformin  have  been  published,  apart  from  reassuring findings in one study with an 18-month follow-up period.  The aim of this article is to review the safety, efficacy and future of metformin in diabetic pregnancy.