{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T10:07:10Z","timestamp":1776679630587,"version":"3.51.2"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2024,8,31]],"date-time":"2024-08-31T00:00:00Z","timestamp":1725062400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,8,31]],"date-time":"2024-08-31T00:00:00Z","timestamp":1725062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Health Research Board Ireland"},{"name":"National University Ireland, Galway"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Diabetologia"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Aims\/hypothesis<\/jats:title>\n                <jats:p>Gestational diabetes mellitus (GDM) is associated with adverse perinatal outcomes because of suboptimal glucose management and glucose control and excessive weight gain. Metformin can offset these factors but is associated with small for gestational age (SGA) infants. We sought to identify risk factors for SGA infants, including the effect of metformin exposure on SGA status.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In this prespecified secondary analysis of the EMERGE trial, which evaluated the effectiveness of metformin vs placebo in treating GDM and found reduced gestational weight gain and longer time to insulin initiation with metformin use, we included women with a live-born infant and known infant birthweight and gestational age at delivery. We compared the numbers of SGA infants in both groups and explored baseline predictive factors to help identify those at highest risk of delivering an SGA infant.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Baseline maternal characteristics were similar between SGA and non-SGA pregnancies. On multivariable-adjusted regression, no baseline maternal variables were associated with SGA status. Mothers of SGA infants were more likely to develop pre-eclampsia or gestational hypertension (18.2% vs 2.0%, <jats:italic>p<\/jats:italic>=0.001; 22.7% vs 5.4%, <jats:italic>p<\/jats:italic>=0.005, respectively); after multivariable adjustment, pre-eclampsia was positively associated with SGA status). Among SGA pregnancies, important perinatal outcomes including preterm birth, Caesarean delivery and neonatal care unit admission did not differ between the metformin and placebo groups (20.0% vs 14.3%, <jats:italic>p<\/jats:italic>=1.00; 50.0% vs 28.6%, <jats:italic>p<\/jats:italic>=0.25; 13.3% vs 42.9%, <jats:italic>p<\/jats:italic>=0.27, respectively).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions\/interpretation<\/jats:title>\n                <jats:p>Pre-eclampsia was strongly associated with SGA infants. Metformin-exposed SGA infants did not display a more severe SGA phenotype than infants treated with placebo.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>Clinical Trials.gov NCT02980276; EudraCT number: 2016-001644-19<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Graphical Abstract<\/jats:title>\n                \n              <\/jats:sec>","DOI":"10.1007\/s00125-024-06252-y","type":"journal-article","created":{"date-parts":[[2024,8,31]],"date-time":"2024-08-31T11:02:19Z","timestamp":1725102139000},"page":"2660-2666","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Metformin and small for gestational age babies: findings of a randomised placebo-controlled clinical trial of metformin in gestational diabetes (EMERGE)"],"prefix":"10.1007","volume":"67","author":[{"given":"Fidelma","family":"Dunne","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Newman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Alvarez-Iglesias","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paula","family":"O\u2019Shea","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Declan","family":"Devane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paddy","family":"Gillespie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aoife","family":"Egan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"O\u2019Donnell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Smyth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,8,31]]},"reference":[{"key":"6252_CR1","doi-asserted-by":"publisher","first-page":"107841","DOI":"10.1016\/j.diabres.2019.107841","volume":"157","author":"L Yuen","year":"2019","unstructured":"Yuen L, Saeedi P, Riaz M et al (2019) Projections of the prevalence of hyperglycaemia in pregnancy in 2019 and beyond: results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract 157:107841. https:\/\/doi.org\/10.1016\/j.diabres.2019.107841","journal-title":"Diabetes Res Clin Pract"},{"issue":"Suppl 1","key":"6252_CR2","doi-asserted-by":"publisher","first-page":"S232","DOI":"10.2337\/dc22-S015","volume":"45","author":"American Diabetes Association Professional Practice Committee","year":"2022","unstructured":"American Diabetes Association Professional Practice Committee (2022) 15. Management of diabetes in pregnancy: standards of medical care in diabetes-2022. Diabetes Care 45(Suppl 1):S232\u2013S243. https:\/\/doi.org\/10.2337\/dc22-S015","journal-title":"Diabetes Care"},{"issue":"24","key":"6252_CR3","doi-asserted-by":"publisher","first-page":"2477","DOI":"10.1056\/NEJMoa042973","volume":"352","author":"CA Crowther","year":"2005","unstructured":"Crowther CA, Hiller JE, Moss JR et al (2005) Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. 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The trial was funded by the Health Research Board of Ireland (HRB), coordinated by the HRB-Clinical Research Facility Galway. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"The authors received non-financial support from Merck Healthcare KGaA and Ascensia, which contributed metformin and matched placebo and blood glucose monitoring strips, respectively.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 relationships and activities"}},{"value":"FD, AE, AS, DD and MOD devised the concept for this trial and FD, AE, CN, AS, DD, PO\u2019S and MO\u2019D wrote the protocol. AA-I and PG performed the statistical analysis. All authors drafted and revised the manuscript and approved the final version to be published. FD and CN are accountable for the integrity of the work as a whole.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution statement"}}]}}