The purpose of this study is to assess if metformin reduces adverse outcomes associated with prediabetes in pregnancy. Our hypothesis is that pregnant women with prediabetes who are treated with metformin will show a greater reduction in large for gestational age infants at birth compared to women treated with the standard of care.
Women in pregnancy are routinely screened for diabetes in the first trimester and those who fall into the prediabetes category by hemoglobin A1c level of 5.7 to 6.4%, fasting plasma glucose of greater than or equal to 100 to 125, or oral glucose tolerance test of greater than or equal to 140 to less than 200 before 14 weeks gestation will be approached for consent in our randomized trial. Once consent is obtained, the subjects will be randomized 1:1 into two parallel groups, the metformin treatment group and the standard of care treatment group (routine prenatal care). A random number generator will allocate the participants to the study groups. Women taking metformin will continue twice daily dosing for the duration of their pregnancy after randomization. Those in the standard of care group will receive routine prenatal care. Both groups will undergo routine gestational diabetes testing by 28 weeks. Obstetric, maternal, and neonatal outcomes will then be assessed of both groups until the 6 week postpartum visit.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Maximum dosage of 500 mg tablets 2 times a day (with each meal)
University of Massachusetts Memorial Medical Center
Worcester, Massachusetts, United States
Birth Weight
Used to determine large for gestational age status
Time frame: At Birth
Number of Participants needing Cesarean Section
Number of Participants with Cesarean Section
Time frame: At Delivery
Number of Participants with Postpartum Hemorrhage
Estimated or quantitative blood loss greater than 1000 mL
Time frame: At Delivery
Number of Participants with Development of Pregnancy Induced Hypertension
Blood pressure, serum laboratory analysis, and urine protein would be assessed for diagnosis
Time frame: Through study completion, starting at 14 weeks until delivery
Development of Gestational Diabetes
A glucose tolerance test would be conducted at 28 weeks of pregnancy to diagnose diabetes
Time frame: Assessed at 28 weeks of pregnancy
Maternal Weight Gain in Pregnancy
Time frame: At enrollment and last prenatal visit, starting at 14 weeks until delivery
Pregnancy Outcome
Number of Participants with Stillbirth, livebirth, pregnancy loss
Time frame: Through study completion, starting at 14 weeks until delivery
Number of Participants with Preterm birth
Less than 37 week delivery
Time frame: At delivery
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Neonatal Intensive Care Unit Admission
Admission to level 2 or greater neonatal ICU and length of stay
Time frame: At delivery and within first 2 days of life
Apgar Score at Birth
\<6 at 1 and 5 minutes
Time frame: At delivery
Number of Participants with Neonatal Birth Trauma
Brachial plexus injury
Time frame: At Delivery
Number of Participants with Shoulder Dystocia
Time frame: At Delivery
Number of Participants with Neonatal Hypoglycemia
Time frame: Within first 2 days of life
Number of Participants with Neonatal Respiratory Distress
Requiring 2 or more hours of respiratory support or oxygen with associated diagnosis
Time frame: At Delivery
Number of Participants with Neonatal Hyperbilirubinemia
Requiring phototherapy
Time frame: Within first 2 days of life
Number of Participants requiring Neonatal Intubation
Time frame: At Delivery
Neonatal Cooling
Need for neonatal cooling within first 48 hours of life
Time frame: Within first 2 days of life
Umbilical Cord Blood Level of C-peptide
Time frame: At Birth
Umbilical Cord Blood Level of Leptin
Time frame: At Birth
Umbilical Cord Blood Level of Insulin
Time frame: At Birth
Placental Pathology
Assessing for malperfusion pathology
Time frame: At Birth