Risk of pre-eclampsia in women taking metformin: a systematic review and meta-analysis

Alqudah, A; McKinley, MC; McNally, R; Graham, U; Watson, CJ; Lyons, TJ; McClements, L

Risk of pre-eclampsia in women taking metformin: a systematic review and meta-analysis

Alqudah, A McKinley, MC McNally, R Graham, U Watson, CJ Lyons, TJ McClements, L

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Publication Type:: Journal Article
Citation:: Diabetic Medicine, 2018, 35 (2), pp. 160 - 172
Issue Date:: 2018-02-01

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Field	Value	Language
dc.contributor.author	Alqudah, A	en_US
dc.contributor.author	McKinley, MC	en_US
dc.contributor.author	McNally, R	en_US
dc.contributor.author	Graham, U	en_US
dc.contributor.author	Watson, CJ	en_US
dc.contributor.author	Lyons, TJ	en_US
dc.contributor.author	McClements, L https://orcid.org/0000-0002-4911-1014	en_US
dc.date.available	2017-10-12	en_US
dc.date.issued	2018-02-01	en_US
dc.identifier.citation	Diabetic Medicine, 2018, 35 (2), pp. 160 - 172	en_US
dc.identifier.issn	0742-3071	en_US
dc.identifier.uri	http://hdl.handle.net/10453/130987
dc.description.abstract	© 2017 Diabetes UK Aims: To perform meta-analyses of studies evaluating the risk of pre-eclampsia in high-risk insulin-resistant women taking metformin prior to, or during pregnancy. Methods: A search was conducted of the Medline, EMBASE, Web of Science and Scopus databases. Both randomized controlled trials and prospective observational cohort studies of metformin treatment vs. placebo/control or insulin either prior to or during pregnancy were selected. The main outcome measure was the incidence of pre-eclampsia in each treatment group. Results: Overall, in five randomized controlled trials comparing metformin treatment (n = 611) with placebo/control (n = 609), no difference in the risk of pre-eclampsia was found [combined/pooled risk ratio (RR), 0.86 (95% CI 0.33–2.26); P = 0.76; I2 = 66%]. Meta-analysis of four cohort studies again showed no significant effect [RR, 1.21 (95% CI 0.56–2.61); P = 0.62; I2 = 30%]. A meta-analysis of eight randomized controlled trials comparing metformin (n = 838) with insulin (n = 836), however, showed a reduced risk of pre-eclampsia with metformin [RR, 0.68 (95% CI 0.48–0.95); P = 0.02; I2 = 0%]. No heterogeneity was present in the metformin vs. insulin analysis of randomized controlled trials, whereas high levels of heterogeneity were present in studies comparing metformin with placebo/control. Pre-eclampsia was a secondary outcome in most of the studies. The mean weight gain from time of enrolment to delivery was lower in the metformin group (P = 0.05, metformin vs. placebo; P = 0.004, metformin vs. insulin). Conclusions: In studies randomizing pregnant women to glucose-lowering therapy, metformin was associated with lower gestational weight gain and a lower risk of pre-eclampsia compared with insulin.	en_US
dc.relation.ispartof	Diabetic Medicine	en_US
dc.relation.isbasedon	10.1111/dme.13523	en_US
dc.subject.classification	Endocrinology & Metabolism	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Diabetes, Gestational	en_US
dc.subject.mesh	Pre-Eclampsia	en_US
dc.subject.mesh	Pregnancy in Diabetics	en_US
dc.subject.mesh	Diabetes Mellitus, Type 2	en_US
dc.subject.mesh	Insulin Resistance	en_US
dc.subject.mesh	Weight Gain	en_US
dc.subject.mesh	Metformin	en_US
dc.subject.mesh	Insulin	en_US
dc.subject.mesh	Hypoglycemic Agents	en_US
dc.subject.mesh	Treatment Outcome	en_US
dc.subject.mesh	Risk Factors	en_US
dc.subject.mesh	Cohort Studies	en_US
dc.subject.mesh	Pregnancy	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Middle Aged	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Randomized Controlled Trials as Topic	en_US
dc.subject.mesh	Young Adult	en_US
dc.subject.mesh	Observational Studies as Topic	en_US
dc.title	Risk of pre-eclampsia in women taking metformin: a systematic review and meta-analysis	en_US
dc.type	Journal Article
utslib.citation.volume	2	en_US
utslib.citation.volume	35	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	1701 Psychology	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Science
pubs.organisational-group	/University of Technology Sydney/Faculty of Science/School of Life Sciences
utslib.copyright.status	open_access
pubs.issue	2	en_US
pubs.publication-status	Published	en_US
pubs.volume	35	en_US

Abstract:

© 2017 Diabetes UK Aims: To perform meta-analyses of studies evaluating the risk of pre-eclampsia in high-risk insulin-resistant women taking metformin prior to, or during pregnancy. Methods: A search was conducted of the Medline, EMBASE, Web of Science and Scopus databases. Both randomized controlled trials and prospective observational cohort studies of metformin treatment vs. placebo/control or insulin either prior to or during pregnancy were selected. The main outcome measure was the incidence of pre-eclampsia in each treatment group. Results: Overall, in five randomized controlled trials comparing metformin treatment (n = 611) with placebo/control (n = 609), no difference in the risk of pre-eclampsia was found [combined/pooled risk ratio (RR), 0.86 (95% CI 0.33–2.26); P = 0.76; I2 = 66%]. Meta-analysis of four cohort studies again showed no significant effect [RR, 1.21 (95% CI 0.56–2.61); P = 0.62; I2 = 30%]. A meta-analysis of eight randomized controlled trials comparing metformin (n = 838) with insulin (n = 836), however, showed a reduced risk of pre-eclampsia with metformin [RR, 0.68 (95% CI 0.48–0.95); P = 0.02; I2 = 0%]. No heterogeneity was present in the metformin vs. insulin analysis of randomized controlled trials, whereas high levels of heterogeneity were present in studies comparing metformin with placebo/control. Pre-eclampsia was a secondary outcome in most of the studies. The mean weight gain from time of enrolment to delivery was lower in the metformin group (P = 0.05, metformin vs. placebo; P = 0.004, metformin vs. insulin). Conclusions: In studies randomizing pregnant women to glucose-lowering therapy, metformin was associated with lower gestational weight gain and a lower risk of pre-eclampsia compared with insulin.

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http://hdl.handle.net/10453/130987