Evidence map›Insulin × pregnancy & neonatal›PMID 21083860›Full record

Trial reportBJOG : an international journal of obstetrics and gynaecology2011

Metformin should be considered in the treatment of gestational diabetes: a prospective randomised study.

H Ijäs, M Vääräsmäki, L Morin-Papunen, R Keravuo, T Ebeling, T Saarela, T Raudaskoski

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in BJOG : an international journal of obstetrics and gynaecology, 2011. The graph read 1 number from its abstract, feeding 2 cells of the map, but none could be read as for or against, so it casts no vote. It is linked to trial NCT02417090 (Metformin Therapy for Gestational Diabetes - Metabolic Late Effects on Child at 9 Years of Age), which is not on this map. Cited by 79 papers, 19 of them syntheses that pooled it.

1number the graph read from it
0cells of the map it votes in
79citing papers in PubMed, 19 pooled it
7.2field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

Read, but not usablea number the graph found but could not read as for or against

Pregnancy & neonatalcomparator not stated · gdm, obesityfeeds 2 cells of the map
RR 1.900.99 to 3.71
There was a tendency to a higher rate of caesarean sections in the metformin group than in the insulin group (RR 1.9; 95% CI 0.99-3.71).
FeedsMetformin×pregnancy & neonatalInsulin×pregnancy & neonatal

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Insulin×pregnancy & neonatal

No readable resultOpen on the map →What to test next →

No other readable study in this cell yet. This paper is the evidence.

Belief with this paperNo claim has been compiled for this cell yet.

Metformin×pregnancy & neonatal

No readable resultOpen on the map →What to test next →

3 readable studies in this cell: 0 favour the treatment, 3 find no difference, 0 favour the comparator.

Belief with this paper
0.00contested · 0 families support, 1 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT02932475831 enrolled · 2017
OR 0.860.63 to 1.19
Association Between Metformin Use in Early Gestational or Type 2 Diabe…PMID 39236318 · 2024
OR 1.040.70 to 1.56

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02417090 completedstarted 2015, after this paper: background citation

Metformin Therapy for Gestational Diabetes - Metabolic Late Effects on Child at 9 Years of Age

Ran2015Enrolled173Registered outcomes1Posted comparisons0ConditionsGestational DiabetesArmsInsulin, Metformin
PMID 18795211PMID 23020608other papers from this trial
Open the trial in the graph
5 · Its place in the literature

Who cites it

79 citing papers in PubMed, 19 syntheses or guidelines pooled it, 228 citations in OpenAlex.

  1. Metformin + Insulin vs. Insulin for GDM and T2DM during pregnancy: systematic review and meta-analysis.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2026 · on this map
    Pooled it
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  4. Metformin versus insulin in gestational diabetes mellitus: a systematic review.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2024
    Pooled it
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  10. Insulin for the treatment of women with gestational diabetes.The Cochrane database of systematic reviews · 2017
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  19. Treatments for gestational diabetes.The Cochrane database of systematic reviews · 2009
    Pooled it
  20. Trial

19 more citing papers are in PubMed but not listed here.

6 · The record

Corrections and comments

7 · Who and what money

Authors and funding

7 authors at 2 institutions in 1 country.

H IjäsDepartment of Obstetrics and Gynaecology, Oulu University Hospital, Oulu, Finland. hilkka.ijas@ppshp.fi
M Vääräsmäki
L Morin-Papunen
R Keravuo
T Ebeling
T Saarela
T Raudaskoski
Oulu University Hospital · FIKajaani University of Applied Sciences · FI

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

objectiveTo examine if oral metformin is as effective as insulin in the prevention of fetal macrosomy in pregnancies complicated with gestational diabetes mellitus (GDM).

designOpen-label prospective randomised controlled study.

settingMaternity outpatient clinics in a secondary and tertiary level hospital in Finland. SAMPLE: One hundred women with GDM who did not attain euglycaemia with diet.

methodsWomen were randomised to therapy with insulin (n = 50) or oral metformin (n = 50).

main outcome measuresIncidence of large-for-gestational-age (LGA) infants and neonatal morbidity.

resultsThere were no statistically significant differences in the incidence of LGA (8.5 versus 10.0%, P = 0.97), mean birthweight, mean cord artery pH or neonatal morbidity between the insulin and metformin groups. Fifteen (31.9%) of the 47 women randomised to metformin needed supplemental insulin. They were more obese (with a body mass index of 36 versus 30 kg/m(2), P = 0.002), had higher fasting blood glucose levels in an oral glucose tolerance test (6.1 versus 5.0 mmol/l, P = 0.001) and needed medical treatment for GDM earlier (26 versus 31 gestational weeks, P = 0.002) than women who were normoglycemic with metformin. There was a tendency to a higher rate of caesarean sections in the metformin group than in the insulin group (RR 1.9; 95% CI 0.99-3.71).

conclusionsMetformin seems to be suitable for the prevention of fetal macrosomy, especially in lean or moderately overweight women developing GDM in late gestation. Women with considerable obesity, high fasting blood glucose and an early need for pharmacological treatment may be more suitable for insulin therapy.

Indexed as

AdultBody Mass IndexDiabetes, GestationalFemaleFetal MacrosomiaHumansHypoglycemic AgentsInsulinMetforminObesityOutpatientsPregnancyProspective StudiesRisk FactorsTreatment OutcomeHypoglycemic AgentsInsulinMetformin

Identifiers

PMID21083860
OpenAlexW1561278284

What OpenQuestion holds

Texttitle and abstract
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.