Oral Concurrent Session 7 - Diabetes
Oral Concurrent Sessions
Kevin S. Shrestha, MD, MPH
Fellow
University of Alabama at Birmingham
Birmingham, Alabama, United States
Claire E. Jensen, MD, MSCR (she/her/hers)
Fellow
University of North Carolina
Chapel Hill, North Carolina, United States
Kim Boggess, MD
Professor
University of North Carolina
Chapel Hill, North Carolina, United States
Gladys (Sandy) A. Ramos, MD
Attending Physician
University of California, San Diego
San Diego, California, United States
Ashley N. Battarbee, MD, MSCR
Assistant Professor
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
Metformin did not improve composite neonatal morbidity among insulin-treated preexisting type 2 diabetes (T2D) in two recent RCTs. Although metformin reduced insulin requirements in the MiTy trial, there was no difference observed in the MOMPOD trial. Given trial heterogeneity, we aimed to determine if baseline insulin requirements modified the effect of metformin on neonatal outcomes.
Study Design:
Secondary analysis of the MOMPOD trial, an RCT of metformin versus placebo in insulin-treated T2D or diabetes diagnosed in early pregnancy. Our primary outcome was the composite of neonatal complications from the parent trial (Table). Total daily dose (TDD) of insulin at randomization was evaluated as an effect modifier of the relationship between metformin and the primary outcome using a likelihood ratio test with p< 0.10 as significant. To further investigate effect modification, we evaluated the association between metformin and outcomes among subgroups with TDD < 30U, >60U, and >90U using multivariable Poisson regression with robust error variance and ordinary least squares regression.
Results:
Of the 794 participants included, the median baseline TDD was 62 units (IQR 35, 88). There was significant interaction between metformin and TDD in relation to the primary outcome (Figure). In subgroup analyses of TDD< 30, metformin was associated with lower risk of composite neonatal outcome, LGA, neonatal fat mass, preterm birth, and NICU admission (Table). However, there were no differences in outcomes with metformin vs placebo among participants with TDD >60, with exception for smaller increase in insulin TDD during pregnancy (Table). Findings were similar for participants with TDD >90U.
Conclusion:
The effect of metformin on neonatal outcomes in the MOMPOD trial cohort differed by baseline insulin requirements. Contrary to our hypothesis, metformin was associated with fewer adverse neonatal outcomes among those with low, not high, TDD. Further studies are needed to confirm our findings and evaluate the reason why metformin is beneficial for pregnancies with low insulin requirements.
