When pharmacological treatment is needed to reach control of gestational diabetes mellitus (GDM), insulin is still first-line agent but metformin has been progressively pointed as an effective alternative. Our aim is to confirm whether metformin is an effective and safe option to insulin, by comparing maternal and foetal outcomes between women with GDM treated with these drugs. Retrospective study including 399 women with GDM, 135 needing pharmacological treatment. Comparison of demographic features, risk factors for GDM, maternal and foetal outcomes between women treated with insulin (G1, 41/135) and those treated with metformin (G2, 94/135). X²/Fisher tests were performed. Significance was set at p < 0.05. Both groups showed similar features and risk factors for GDM, except for chronic hypertension, more prevalent in G1. Therapy with insulin showed poorer metabolic control with higher rate of pregnant with HbA1c ≥ 6% (42 mmol/mol) (25.6 vs 4.5%, p = 0.001) and more polihydramnios (14.6% vs 3.2%, p = 0.023). A higher rate of caesarean was observed in G1, however, with no statistical difference (42.5% vs 26.9%, p = 0.076). There were more newborns weighing < 2500 g in women treated with metformin. No other outcome showed difference with statistical significance, namely maternal weight gain, macrosomia or neonatal comorbidities. Metformin allowed a good metabolic control with maternal and foetal outcomes similar to insulin. Metformin has proven effective as a pharmacological option to insulin. Prospective and randomized studies are needed as well as evaluation of long term benefits of metformin.

中文翻译：

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二甲双胍作为妊娠期糖尿病胰岛素的安全选择：一项回顾性研究

当需要药物治疗以控制妊娠糖尿病（GDM）时，胰岛素仍是一线药物，但二甲双胍已逐渐被认为是一种有效的替代药物。我们的目的是通过比较接受这些药物治疗的GDM妇女的母婴结局，来确定二甲双胍是否是胰岛素的有效和安全选择。回顾性研究包括399名GDM妇女，其中135名需要药物治疗。接受胰岛素治疗的女性（G1，41 / 135）和接受二甲双胍治疗的女性（G2，94 / 135）的人口统计学特征，GDM危险因素，母婴结局比较。进行X ² / Fisher测试。重要性设定为p <0.05。两组均显示出相似的GDM特征和危险因素，但慢性高血压除外，在G1中更为普遍。胰岛素治疗显示代谢控制较差， HbA1c≥6 ％（42 mmol / mol）的孕妇发生率更高（25.6 vs 4.5％，p = 0.001）和更多的羊水过多（14.6％vs 3.2％，p  = 0.023）。在G1中观察到较高的剖腹产率，但无统计学差异（p.42.5％vs 26.9％，p = 0.076）。用二甲双胍治疗的妇女中，体重<2500 g的新生儿更多。没有其他结果显示具有统计学意义的差异，即孕产妇体重增加，巨人症或新生儿合并症。二甲双胍可实现良好的代谢控制，其母体和胎儿的结局类似于胰岛素。二甲双胍已被证明可以有效地替代胰岛素。需要进行前瞻性和随机研究，以及评估二甲双胍的长期获益。