Abstract Aims This systematic review and meta‐analysis assessed the safety and efficacy of metformin in managing gestational diabetes mellitus (GDM), focusing on maternal, neonatal and long‐term outcomes. While lifestyle changes are first‐line treatment, pharmacological therapy is often required. Insulin, the standard, has drawbacks including weight gain, neonatal hypoglycaemia and maternal anxiety. Metformin is a promising alternative due to its insulin‐sensitizing effects, but concerns remain about placental transfer and long‐term effects on offspring. Methods A systematic search was conducted in PubMed and Embase up to 29 August 2024, including randomized controlled trials (RCTs) and follow‐up studies. Primary outcomes were neonatal hypoglycaemia, birthweight and long‐term metabolic outcomes. Study quality was assessed using RoB 2.0 and ROBINS‐I. Data were synthesized using the IVhet model. Results Ten RCTs were included. Metformin was associated with a statistically significant reduction in neonatal hypoglycaemia (OR: 0.65, 95% CI: 0.46–0.92) and lower birthweight (MD: −68.96 g, 95% CI: −108.34 to −29.57). A non‐significant trend towards reduced LGA risk was observed. No significant differences in prediabetes, diabetes or insulin resistance were found. Long‐term outcomes in children remain uncertain due to limited and heterogeneous follow‐up data. Conclusions Metformin appears safe and effective in GDM management, but more data are needed on long‐term outcomes.
Krasilnikoff et al. (2025) studied this question.