Comparison of pregnancy outcomes and physical conditions of infants in patients with gestational diabetes mellitus treated with metformin and insulin: a meta-analysis study.

BACKGROUND

Gestational diabetes mellitus (GDM) is a common complication during pregnancy, which seriously affects the health of mothers and infants. Metformin and insulin are both commonly used therapeutic drugs, but the effects of the two on pregnancy outcomes and the physical condition of the infants remain undetermined. This study conducted a meta-analysis to compare the effects of two drugs in the treatment of gestational diabetes mellitus (GDM), providing a basis for clinical medication.

METHODS

Our research systematically searched the PubMed, Embase, and Cochrane Library databases to include randomized controlled trials (RCTS) of metformin and insulin in the treatment of GDM. The search period was up to March 2025. Literature screening, data extraction and quality evaluation were independently completed by two researchers, and statistical analysis was performed using RevMan 5.4 software.

RESULTS

Eventually, 8 RCTS were included, involving a total of 2,350 patients with GDM. Meta-analysis showed that the cesarean section rate in the metformin group was 26.3%, which was lower than 33.7% in the insulin group (RR = 0.78, 95%CI:0.75–0.81, P < 0.05). The incidence of gestational hypertension in the metformin group was 13.8% (26 out of 188 patients), which was lower than 18.6% (34 out of 183 patients) in the insulin group (RR = 0.74, 95% CI: 0.69–0.79, P < 0.05). The cesarean section rate was 30.9% (58/188) in the metformin group vs. 38.8% (71/183) in the insulin group (RR = 0.78, 95% CI:0.75–0.81, P < 0.05). Neonatal hypoglycemia occurred in 5.9% (11/188) of the metformin group vs. 9.8% (18/183) of the insulin group (RR = 0.60, 95% CI:0.57–0.63, P < 0.05). Macrosomia rates were 14.9% (28/188) vs. 19.7% (36/183) in the two groups, respectively (RR = 0.78, 95% CI:0.73–0.83, P < 0.05).

CONCLUSION

Compared with insulin, metformin in the treatment of gestational diabetes mellitus can reduce the rate of cesarean section, the incidence of gestational hypertension, the incidence of neonatal hypoglycemia and the incidence of macrosomia, and can be an effective treatment option for patients with GDM.