Gestational weight gain according to treatment in gestational diabetes: a systematic review and meta-analysis

Amaral-Moreira, Carolina de Freitas Alves; Paulino, Daiane Sofia de Morais; Guida, José Paulo Siqueira; Pereira, Belmiro Gonçalves; Rehder, Patrícia Moretti; Surita, Fernanda Garanhani

doi:10.61622/rbgo/2025rbgo65

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Review article • Rev Bras Ginecol Obstet 47 • 2025 • https://doi.org/10.61622/rbgo/2025rbgo65 linkcopy

Gestational weight gain according to treatment in gestational diabetes: a systematic review and meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: In this systematic review, we aim to compare the GWG in pregnant women with diabetes treated with metformin and other interventions

Methods: Data Sources: The searched baselines included PubMed, Scopus, Web of Science, Embase, and Virtual Health Library (BVS). Study selection: We selected articles that compared the GWG in women with diabetes treated with metformin or insulin. We have included clinical trials (randomized or not), observational studies (cohort, case control, and cross-sectional). Reviews (systematic or not), posters, event abstracts, and letters were excluded. Data Collection: We pooled odds ratios (OR) and mean difference (MD) and used a random effect model using R Studio software to compare the weight gain, fetal birthweight and preeclampsia according to treatment.

Results: On research conducted in January 2024, with no data limit of the search, 433 trials were identified, of which 175 remained after duplicate removal. 50 studies were analyzed in the full text analyses and 9 were selected for the systematic review. 8 studies demonstrated that gestational weight gain during metformin treatment is lower when compared to other treatments, especially insulin, although it was not different from other outcomes. Meta-analyses demonstrated that oral medication GWG is lower than insulin with a standard mean difference (SMD) -1,05 [-1,87, - 0,23].

Conclusion: Oral medication has a lower gestational weight gain in patients with gestational diabetes when compared to insulin.

International Prospective register of Systematic Reviews (PROSPERO): CRD 42024492158

Keywords
Gestational diabetes; Gestational weight gain; Metformin; Insulin

Author	Title	Country	Study design	Inclusion	Analyzed groups	GWG	Other Outcomes
Ainuddin et al. (2015)(¹⁵)	Metformin treatment in type 2 diabetes in pregnancy: An active controlled, parallel-group, randomized, open label study in patients with type 2 diabetes in pregnancy	Pakistan	RCT	DM2	metformin +- insulin X insulin	GWG was lower in the metformin group	Metformin group had lower rates of pregnancy induced hypertension and hypoglycemia, but had higher rates of small for gestational age
Ainuddin et al. (2015)(¹⁶)	Metformin versus insulin treatment in gestational diabetes in pregnancy in a developing country. A randomized control trial.	Pakistan	RCT	GDM	metformin +- insulin X insulin	GWG was lower in the metformin group	Metformin group had lower rates or preeclampsia, neonatal morbidity and lower mean birth weight
Galal et al. (2019)(¹⁷)	Metformin versus insulin in treatment of gestational diabetes mellitus: A randomized controlled trial.	Egypt	RCT	GDM	metformin x insulin	GWG was lower in the metformin group	Metformin was cost effectiveness. Metformin had lower rates of hypoglycemia
Bettencourt-Silva et al. (2019)(¹⁸)	Metformin in overweight and obese women with gestational diabetes: a propensity score-matched study	Portugal	Cohort	GDM and overweight or obesity	metformin x insulin	Metformin had lower rates of excessive GWG and more adequate GWG	There was no difference in the other outcomes
Huhtala et al. (2020)(¹⁹)	Metformin and insulin treatment of gestational diabetes: Effects on inflammatory markers and IGF-binding protein-1 – Secondary analysis of a randomized controlled trial.	Finland	RCT	GDM	Metformin X insulin	GWG was lower in the metformin group	Metformin group had smaller babies
Niromanesh et al. (2012)(²⁰)	Metformin compared with insulin in the management of gestational diabetes mellitus: a randomized clinical trial	Iran	RCT	GDM	Metformin X insulin	GWG was lower in the metformin group	Metformin group had a higher incidence of smaller babies.
Roy et al. (2018)(²¹)	The use of metformin versus insulin in the management of diabetes mellitus in pregnancy . a randomized control tria	India	RCT	GDM	metformin +- insulin X insulin	GWG was lower in the metformin group	No difference in other outcomes
Silva et al. (2010)(²²)	Metformin compared with glyburide for the management of gestational diabetes	Brazil	RCT	GDM	metformin +- insulin X glyburide	GWG was lower in the metformin group	No difference in other outcomes
Hay et al. (2022)(²³)	Prescribing patterns and outcomes among patients treated for gestational diabetes mellitus.	USA	Cohort	GDM	metformin x insulin xgliburide	There was no difference in the GWG between groups	Other outcomes were similar between groups

Author	Title	participants	Metformin	Met+ insulin	insulin	glyburide	Mean age	Mean BMI
Ainuddin et al. (2015)(¹⁵)	Metformin treatment in type 2 diabetes in pregnancy: An active controlled, parallel-group, randomized, open label study in patients with type 2 diabetes in pregnancy	206	16	90	100	0	31	28-35 kg/m²
Ainuddin et al. (2015)(¹⁶)	Metformin versus insulin treatment in gestational diabetes in pregnancy in a developing country. A randomized control trial.	150	43	32	75	0	30-31	66-67kg
Galal et al. (2019)(¹⁷)	Metformin versus insulin in treatment of gestational diabetes mellitus: A randomized controlled trial.	106	52	0	54	0	32	30 kg/m²
Bettencourt-Silva et al. (2019)(¹⁸)	Metformin in overweight and obese women with gestational diabetes: a propensity score-matched study	457	0	177	280	0	34	78-86kg/30-32 kg/m²
Huntala et al. (2020)(¹⁹)	Metformin and insulin treatment o fgestational diabetes: Effects on inflammatory markers and IGF-binding protein-1 - Secondary analysis of a randomized controlled trial.	227	43	32	75	0	30-31	66-70 kg
Niromanesh et al. (2012)(²⁰)	Metformin compared with insulin in the management of gestational diabetes mellitus: a randomized clinical trial	172	80	0	80	0	30-32	27-28 kg/m²
Roy et al. (2018)(²¹)	The use of metformin versus insulin in the management of diabetes mellitus in pregnancy . a randomized control tria	160	80	0	80	0	30-31	26kg/m²
Silva et al. (2010)(²²)	Metformin compared with glyburide for the management of gestational diabetes	72	40	0	0	32	31-33	28-30 kg/m²
Hay et al. (2022)(²³)	Prescribing patterns and outcomes among patients treated for gestational diabetes mellitus.	368	50	0	13	283	31	91-98 kg

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