University of Galway researchers find new drug for gestational diabetes management in pregnant women

By Ella Carey

Researchers at University of Galway have taken a significant step forward in the management of gestational diabetes mellitus and have provided new hope for expectant mothers suffering the condition.

The findings from the clinical trial involving pregnant women have been published in JAMA: the Journal of American Medical Association.

Gestational diabetes is a global health issue affecting almost 3 million pregnant women worldwide every year. It is a condition characterised by elevated blood sugar levels during pregnancy, posing increased health risks for both mothers and their babies. 

Professor Fidelma Dunne, Professor of Medicine at University of Galway and Consultant Endocrinologist at Saolta University Health Care Group, managed the EMERGE, randomised, placebo-controlled trial, involving more than 500 pregnant women.

Results

The study found that women assigned to metformin were 25% less likely to need insulin, and when insulin was necessary, it was started later in the pregnancy. Women receiving metformin gained less weight throughout the trial and maintained this weight difference at the 12-week post-delivery visit.

Importantly, the study found that delivery occurred at the same mean gestational age (39.1 weeks) in both groups.

There was no evidence of any increase in preterm birth (birth before 37 weeks) among those who received the drug.

The study also revealed no differences in adverse neonatal outcomes, including the need for intensive care treatment for new-borns, respiratory support, jaundice, congenital anomalies, birth injuries or low sugar levels.

Additionally there were no variations in rates of labour induction, caesarean delivery, maternal haemorrhage, infection or blood pressure issues during or after birth. 

Professor Fidelma Dunne presented the results on Tuesday (October 3) at the 59^th Annual Meeting of the European Association for the Study of Diabetes in Hamburg, Germany.

Tackling uncertainties

Professor Dunne said that although there is evidence improved sugar control correlated with better pregnancy outcomes, there was uncertainty about the best way to manage, following a diagnosis of gestational diabetes:

“In our pursuit of a safe and effective treatment option we explored an alternative approach – administering the drug metformin. A previous trial compared metformin to insulin and found it to be effective, yet concerns remained, especially regarding preterm birth and infant size.”

To address concerns, the team at University of Galway conducted a ground-breaking placebo-controlled-trial, filling a critical gap in the gestational diabetes treatment landscape. 

535 pregnant women took part in this trial, with 268 receiving metformin and 267 a placebo.

98% of women remained in the trial until delivery, with 88% completing the 12-week post-delivery follow up assessment.

Only 4.9% of women discontinued medication due to side effects, highlighting the safety of the interventions. 

Professor Dunne added that:

“The results from the EMERGE study are a significant step forward for women with gestational diabetes. Metformin has emerged as an effective alternative for managing gestational diabetes, offering new hope for expectant mothers and healthcare providers worldwide.”