Meta-analysis suggests that metformin may reduce pre-eclampsia compared with insulin use during pregnancy

Commentary on : Alqudah A, McKinley MC, McNally R et al Risk of pre-eclampsia in women taking metformin: a systematic review and meta-analysis. Diabet Med 2018;35:160–172. Pre-eclampsia occurs in 2%–5% of pregnancies and is an important cause of maternal and fetal morbidity and mortality. The risk of pre-eclampsia increases 2.9 fold in obese women and 4.47 fold in women with glucose intolerance, and is therefore of particular concern in these populations. Metformin has been studied in three populations during pregnancy: women with polycystic ovary syndrome (PCOS), women with glucose intolerance (gestational diabetes (GDM) and occasionally women with type 2 diabetes (T2DM)) and in obese pregnant women. However, the effect of metformin on pre-eclampsia remains unclear, with variable results in all three populations. In the two randomised controlled trials (RCTs) of metformin use in obese women, one showed a significant reduction in pre-eclampsia while the other showed no difference. Results in women with PCOS have been conflicting …