Metformin in women with type 2 diabetes in pregnancy (MiTy):
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Although metformin is increasingly being used in women with type 2 diabetes during pregnancy, little data exist on the benefits and harms of metformin use on pregnancy outcomes in these women. Researchers aimed to investigate the effects of the addition of metformin to a standard regimen of insulin on neonatal morbidity and mortality in pregnant women with type 2 diabetes.

Between May 25, 2011, and Oct 11, 2018, researchers randomly assigned 502 women, 253 (50%) to metformin, and 249 (50%) to placebo. Complete data were available for 233 (92%) participants in the metformin group and 240 (96%) in the placebo group for the primary outcome. Theyfound no significant difference in the primary composite neonatal outcome between the two groups. Compared with women in the placebo group, metformin-treated women achieved better glycaemic control, required less insulin, gained less weight, compared with those in the placebo group, metformin-exposed infants weighed less, and metformin-exposed infants had reduced adiposity measures.

Researchers found several maternal glycaemic and neonatal adiposity benefits in the metformin group. Along with reduced maternal weight gain and insulin dosage and improved glycaemic control, the lower adiposity and infant size measurements resulted in fewer large infants but a higher proportion of small-for-gestational-age infants. Understanding the implications of these effects on infants will be important to properly advise patients who are contemplating the use of metformin during pregnancy.