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Metformin use in pregnancy: promises and uncertainties

Metformin has been prescribed in pregnancy for over 40 years; for much of this time, use has been limited both in numbers and geographically, and the evidence base has been confined to observational studies. In early years, perceived safety concerns and lack of availability of the drug in many count...

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Autores principales: Lindsay, Robert S., Loeken, Mary R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5552827/
https://www.ncbi.nlm.nih.gov/pubmed/28770325
http://dx.doi.org/10.1007/s00125-017-4351-y
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author Lindsay, Robert S.
Loeken, Mary R.
author_facet Lindsay, Robert S.
Loeken, Mary R.
author_sort Lindsay, Robert S.
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description Metformin has been prescribed in pregnancy for over 40 years; for much of this time, use has been limited both in numbers and geographically, and the evidence base has been confined to observational studies. In early years, perceived safety concerns and lack of availability of the drug in many countries acted as a barrier to use. More recently, RCTs have begun to examine the role of metformin in pregnancy in much-needed detail. However, this evidence base has been interpreted differently in different countries, leading to very wide variation in its current application in pregnancy. In this short review, we will discuss the history of metformin in pregnancy and highlight some of the key clinical trials. We will then consider some of the remaining controversies associated with metformin use in pregnancy, most important of these being the potential for long-term ‘programming’ effects on the fetus as a result of metformin being able to cross the placenta. We will also consider clinical situations where metformin might be avoided. Finally, we will discuss some future directions for this drug as it reaches its sixtieth anniversary. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00125-017-4351-y) contains a slide of the figure for download, which is available to authorised users.
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spelling pubmed-55528272017-08-25 Metformin use in pregnancy: promises and uncertainties Lindsay, Robert S. Loeken, Mary R. Diabetologia Review Metformin has been prescribed in pregnancy for over 40 years; for much of this time, use has been limited both in numbers and geographically, and the evidence base has been confined to observational studies. In early years, perceived safety concerns and lack of availability of the drug in many countries acted as a barrier to use. More recently, RCTs have begun to examine the role of metformin in pregnancy in much-needed detail. However, this evidence base has been interpreted differently in different countries, leading to very wide variation in its current application in pregnancy. In this short review, we will discuss the history of metformin in pregnancy and highlight some of the key clinical trials. We will then consider some of the remaining controversies associated with metformin use in pregnancy, most important of these being the potential for long-term ‘programming’ effects on the fetus as a result of metformin being able to cross the placenta. We will also consider clinical situations where metformin might be avoided. Finally, we will discuss some future directions for this drug as it reaches its sixtieth anniversary. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00125-017-4351-y) contains a slide of the figure for download, which is available to authorised users. Springer Berlin Heidelberg 2017-08-02 2017 /pmc/articles/PMC5552827/ /pubmed/28770325 http://dx.doi.org/10.1007/s00125-017-4351-y Text en © The Author(s) 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Review
Lindsay, Robert S.
Loeken, Mary R.
Metformin use in pregnancy: promises and uncertainties
title Metformin use in pregnancy: promises and uncertainties
title_full Metformin use in pregnancy: promises and uncertainties
title_fullStr Metformin use in pregnancy: promises and uncertainties
title_full_unstemmed Metformin use in pregnancy: promises and uncertainties
title_short Metformin use in pregnancy: promises and uncertainties
title_sort metformin use in pregnancy: promises and uncertainties
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5552827/
https://www.ncbi.nlm.nih.gov/pubmed/28770325
http://dx.doi.org/10.1007/s00125-017-4351-y
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