ArticleBMJ open diabetes research & care2022
Metformin in pregnancy and risk of adverse long-term outcomes: a register-based cohort study.
Article in BMJ open diabetes research & care, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 5 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
33 citing papers in PubMed, 5 syntheses or guidelines pooled it, 70 citations in OpenAlex.
- Intrauterine metformin exposure and adiposity outcomes in children: a systematic review and meta-analysis.BMJ open · 2025Pooled it
- Metformin use in gestational diabetes mellitus and neonatal outcomes: a systematic review and meta-analysis on the risk of small for gestational age.Frontiers in medicine · 2025Pooled it
- Systematic review and meta-analysis of birth outcomes in women with polycystic ovary syndrome.Nature communications · 2024Pooled it
- Fetal and post-natal outcomes in offspring after intrauterine metformin exposure: A systematic review and meta-analysis of animal experiments.Diabetic medicine : a journal of the British Diabetic Association · 2024Pooled it
- Effects of GLP-1 agonists and SGLT2 inhibitors during pregnancy and lactation on offspring outcomes: a systematic review of the evidence.Frontiers in endocrinology · 2023Pooled it
- Metformin Versus Insulin for Gestational Diabetes: Cognitive and Neuropsychological Profiles of Children Aged 9 years.Journal of developmental and behavioral pediatrics : JDBP · 2023Trial
- Metformin Exposure in Pregnancy and Childhood Developmental Outcomes.JAMA network open · 2026Article
- Metformin Exposure in Pregnancy and Fetal Programming: A Focused Review of Contemporary Evidence.Biomedicines · 2026Review
- Metformin and Hypertensive Disorders of Pregnancy: A Phenotype-Based Focused Narrative Review.Journal of clinical medicine · 2026Review
- Hyperandrogenemia Induces Trophoblast Ferroptosis and Early Pregnancy Loss in Patients With PCOS via CMA-Dependent FTH1 Degradation.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026Article
- The impact of obesity on pregnancy outcomes in women with type 1 and type 2 diabetes across the NSW population: A retrospective cohort study.Diabetic medicine : a journal of the British Diabetic Association · 2026Article
- Effectiveness of Metformin Prolonged-Release Formulation on Achievement of Optimal Glycemic Control in Gestational Diabetes Mellitus: Protocol for a Pilot, Randomized, Double-Blind, Clinical Trial.JMIR research protocols · 2025Article
- Foetal Metformin Exposure, Childhood Adiposity and Future Cardiovascular Risk: Can We Connect the Dots?TouchREVIEWS in endocrinology · 2025Review
- Gestational diabetes: update on screening, diagnosis and maternal management.Australian prescriber · 2025Review
- The Effects of Maternal Endocrinopathies and Exposure to Endocrine Disruptors During Pregnancy on the Fetus and Newborn.Biomedicines · 2025Review
- Metformin use in gestational diabetes is not associated with an increased risk of preterm labor and small for gestational age infants compared to diet control alone.BMC pregnancy and childbirth · 2025Article
- Long-term effects of metformin on offspring health: A review of current evidence and future directions.Diabetes, obesity & metabolism · 2025Review
- A narrative review of metformin in pregnancy: Navigating benefit and uncertainty.Diabetes, obesity & metabolism · 2025Review
- Metformin in polycystic ovary syndrome: unraveling multi-stage therapeutic mechanisms from puberty to long-term health outcomes.Frontiers in pharmacology · 2025Review
- TNFSF14The EMBO journal · 2024Article
Corrections and comments
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Authors and funding
11 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThis study aimed to investigate if maternal pregnancy exposure to metformin is associated with increased risk of long-term and short-term adverse outcomes in the child. RESEARCH DESIGN AND
methodsThis register-based cohort study from Finland included singleton children born 2004-2016 with maternal pregnancy exposure to metformin or insulin (excluding maternal type 1 diabetes): metformin only (n=3967), insulin only (n=5273) and combination treatment (metformin and insulin; n=889). The primary outcomes were long-term offspring obesity, hypoglycemia, hyperglycemia, diabetes, hypertension, polycystic ovary syndrome, and challenges in motor-social development. In a sensitivity analysis, the primary outcomes were investigated only among children with maternal gestational diabetes. Secondary outcomes were adverse outcomes at birth. Analyses were conducted using inverse- probability of treatment weighting (IPTW), with insulin as reference.
resultsExposure to metformin or combination treatment versus insulin was not associated with increased risk of long-term outcomes in the main or sensitivity analyses. Among the secondary outcomes, increased risk of small for gestational age (SGA) was observed for metformin (IPTW-weighted OR 1.65, 95% CI 1.16 to 2.34); increased risk of large for gestational age, preterm birth and hypoglycemia was observed for combination treatment. No increased risk was observed for neonatal mortality, hyperglycemia, or major congenital anomalies.
conclusionsThis study found no increased long-term risk associated with pregnancy exposure to metformin (alone or in combination with insulin), compared with insulin. The increased risk of SGA associated with metformin versus insulin suggests caution in pregnancies with at-risk fetal undernutrition. The increased risks of adverse outcomes at birth associated with combination treatment may reflect confounding by indication or severity.
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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.