{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T22:59:52Z","timestamp":1783810792831,"version":"3.55.0"},"reference-count":40,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T00:00:00Z","timestamp":1706572800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002960","name":"V\u00e4sterbotten L\u00e4ns Landsting","doi-asserted-by":"publisher","award":["C\u2010ALF 7004352"],"award-info":[{"award-number":["C\u2010ALF 7004352"]}],"id":[{"id":"10.13039\/501100002960","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004885","name":"Ume\u00e5 Universitet","doi-asserted-by":"publisher","award":["310426017\u2010Holmstens Foundation"],"award-info":[{"award-number":["310426017\u2010Holmstens Foundation"]}],"id":[{"id":"10.13039\/501100004885","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Neonatal hypoglycemia is a common complication associated with gestational diabetes and therefore relevant to consider in evaluations of maternal treatment. We aimed to investigate the risk of neonatal hypoglycemia in offspring exposed to metformin treatment alone (MT) or combined with insulin (MIT) in comparison with nutrition therapy alone (NT), and insulin treatment alone (IT). In addition, we investigated MT in comparison with MIT. Secondary outcomes included neonatal anthropometrics, respiratory morbidity, hyperbilirubinemia, 5\u2010min Apgar score, and preterm birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>This Swedish population\u2010based cohort included 16\u2009181 women diagnosed with gestational diabetes, and their singleton offspring born in 2019\u20132021. We estimated risk as adjusted odds ratio (aOR) with 95% confidence interval (CI), using individual\u2010level, linkage register\u2010data in multivariable logistic regression models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the main analysis, MT was associated with a lower risk of neonatal hypoglycemia vs NT (aOR 0.85, 95% CI: 0.74\u20130.96), vs MIT (0.74 [0.64\u20130.87]), and vs IT (0.47 [0.40\u20130.55]), whereas MIT was associated with a similar risk of neonatal hypoglycemia vs NT (1.14 [0.99\u20131.30]) and with lower risk vs IT (0.63 [0.53\u20130.75]). However, supplemental feeding rates were lower for NT vs pharmacological treatments (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). In post hoc subgroup analyses including only exclusively breastfed offspring, the risk of neonatal hypoglycemia was modified and similar among MT and NT, and higher in MIT vs NT. Insulin exposure, alone or combined with metformin, was associated with increased risk of being large for gestational age. Compared with NT, exposure to any pharmacological treatment was associated with significantly lower risk of 5\u2010min Apgar score\u2009&lt;\u20094. All other secondary outcomes were comparable among the treatment categories.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The risk of neonatal hypoglycemia appears to be comparable among offspring exposed to single metformin treatment and nutrition therapy alone, and the lower risk that we observed in favor of metformin is probably explained by a difference in supplemental feeding practices rather than metformin per se. By contrast, the lower risk favoring metformin exposure over insulin exposure was not explained by supplemental feeding. However, further investigations are required to determine whether the difference is an effect of metformin per se or mediated by other external factors.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14787","type":"journal-article","created":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T10:28:34Z","timestamp":1706610514000},"page":"992-1007","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Neonatal outcome following metformin\u2010treated gestational diabetes mellitus: A population\u2010based cohort study"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6868-4750","authenticated-orcid":false,"given":"Johanna","family":"Molin","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences Ume\u00e5 University  Ume\u00e5 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus","family":"Domell\u00f6f","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Ume\u00e5 University  Ume\u00e5 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christel","family":"H\u00e4ggstr\u00f6m","sequence":"additional","affiliation":[{"name":"Northern Registry Center, Department of Public Health and Clinical Medicine Ume\u00e5 University  Ume\u00e5 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eszter","family":"Vanky","sequence":"additional","affiliation":[{"name":"Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences Norwegian University of Science and Technology  Trondheim Norway"},{"name":"Department of Obstetrics and Gynecology St. Olav's Hospital, Trondheim University Hospital  Trondheim Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itay","family":"Zamir","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Ume\u00e5 University  Ume\u00e5 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"\u00d6stlund","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Education S\u00f6dersjukhuset, Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Bixo","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Ume\u00e5 University  Ume\u00e5 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,30]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0707943"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2021-002363"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu14163364"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2017.1579"},{"key":"e_1_2_13_6_1","article-title":"Treatments for women with gestational diabetes mellitus: an overview of cochrane systematic reviews","volume":"8","author":"Martis R","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-019-2343-2"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2019-000759"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms19071954"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2004.11.051"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.13150"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2022-003056"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.3889\/oamjms.2018.200"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm7030050"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1258\/om.2012.110092"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jped.2016.04.004"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2011.03361.x"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2014.08.004"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2020.108642"},{"key":"e_1_2_13_20_1","unstructured":"The Swedish Board of Health and Welfare.Nationella riktlinjer\u2010Utv\u00e4rdering 2015\u2010Diabetesv\u00e5rd\u2010Indikatorer och underlag f\u00f6r bed\u00f6mningar [National guidelines\u2010Evaluation 2015\u2010Diabetes Care\u2010Indicators and basis for assessments] (in Swedish online).2015. 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