{
    "abstract": "During pregnancy, the complex hormonal changes lead to a progressive decrease of insulin sensitivity that can drive the onset of gestational diabetes (GDM) or worsen an already-known condition of insulin resistance like type 2 diabetes, polycystic ovarian syndrome (PCOS), and obesity, with complications for the mother and the fetus. Metformin during pregnancy is proving to be safe in a growing number of studies, although it freely crosses the placenta, leading to a fetal level similar to maternal concentration. The aim of this literature review is to analyze the main available evidence on the use of metformin during, throughout, and beyond pregnancy, including fertilization, lactation, and medium-term effects on offspring. Analyzed studies support the safety and efficacy of metformin during pregnancy. In pregnant women with GDM and type 2 diabetes, metformin improves obstetric and perinatal outcomes. There is no evidence that it prevents GDM in women with pregestational insulin resistance or improves lipid profile and risk of GDM in pregnant women with PCOS or obesity. Metformin could have a role in reducing the risk of preeclampsia in pregnant women with severe obesity, the risk of late miscarriages and preterm delivery in women with PCOS, and the risk of ovarian hyperstimulation syndrome, increasing the clinical pregnancy rate in women with PCOS undergoing ",
    "authors": [
        {
            "affiliation": "Diabetes Care Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy.\nCatholic University School of Medicine, Rome, Italy.",
            "firstname": "Giulia",
            "initials": "G",
            "lastname": "Tosti"
        },
        {
            "affiliation": "Diabetes Care Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy.\nCatholic University School of Medicine, Rome, Italy.",
            "firstname": "Annarita",
            "initials": "A",
            "lastname": "Barberio"
        },
        {
            "affiliation": "Diabetes Care Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy.\nCatholic University School of Medicine, Rome, Italy.",
            "firstname": "Linda",
            "initials": "L",
            "lastname": "Tartaglione"
        },
        {
            "affiliation": "Diabetes Care Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy.\nCatholic University School of Medicine, Rome, Italy.",
            "firstname": "Alessandro",
            "initials": "A",
            "lastname": "Rizzi"
        },
        {
            "affiliation": "Diabetes Care Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy.\nCatholic University School of Medicine, Rome, Italy.",
            "firstname": "Mauro",
            "initials": "M",
            "lastname": "Di Leo"
        },
        {
            "affiliation": "Diabetes Care Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy.\nCatholic University School of Medicine, Rome, Italy.",
            "firstname": "Luca",
            "initials": "L",
            "lastname": "Viti"
        },
        {
            "affiliation": "Catholic University School of Medicine, Rome, Italy.\nDepartment of Woman and Child Health, Woman Health Area Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy.",
            "firstname": "Angelo",
            "initials": "A",
            "lastname": "Sirico"
        },
        {
            "affiliation": "Catholic University School of Medicine, Rome, Italy.\nDepartment of Woman and Child Health, Woman Health Area Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy.",
            "firstname": "Sara",
            "initials": "S",
            "lastname": "De Carolis"
        },
        {
            "affiliation": "Catholic University School of Medicine, Rome, Italy.\nDepartment of Endocrinology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy.",
            "firstname": "Alfredo",
            "initials": "A",
            "lastname": "Pontecorvi"
        },
        {
            "affiliation": "Catholic University School of Medicine, Rome, Italy.\nDepartment of Woman and Child Health, Woman Health Area Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy.",
            "firstname": "Antonio",
            "initials": "A",
            "lastname": "Lanzone"
        },
        {
            "affiliation": "Diabetes Care Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy.\nCatholic University School of Medicine, Rome, Italy.",
            "firstname": "Dario",
            "initials": "D",
            "lastname": "Pitocco"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2023 Tosti, Barberio, Tartaglione, Rizzi, Di Leo, Viti, Sirico, De Carolis, Pontecorvi, Lanzone and Pitocco.",
    "doi": "10.3389/fendo.2023.1176623\n10.1097/GRF.0b013e31815a5494\n10.1210/jcem-67-2-341\n10.1155/2019/5320156\n10.1097/00006254-199401000-00027\n10.1016/j.biopha.2021.111315\n10.1210/edrv.18.6.0318\n10.2337/db12-0073\n10.1056/NEJMoa0707943\n10.1007/s11892-019-1267-6\n10.1155/2011/218598\n10.3390/ijms23031264\n10.1210/endrev/bnaa023\n10.1358/dot.2008.44.4.1138124\n10.1124/dmd.109.031245\n10.1136/bmjdrc-2021-002363\n10.3390/ijms19071954\n10.1056/NEJMoa0707193\n10.1111/j.1471-0528.2010.02763.x\n10.1111/j.1464-5491.2011.03361.x\n10.1016/j.diabres.2012.09.031\n10.1111/dom.12017\n10.1016/j.ajog.2013.03.022\n10.1371/journal.pone.0064585\n10.1080/14767058.2019.1670804\n10.1016/j.ajog.2021.04.229\n10.1111/jog.13477\n10.1016/S2213-8587(20)30310-7\n10.1016/S2213-8587(15)00219-3\n10.1016/S2213-8587(18)30310-3\n10.20945/2359-3997000000251\n10.1016/j.orcp.2020.09.005\n10.1093/humrep/deh347\n10.1210/jc.2010-0853\n10.1111/aogs.12015\n10.1016/S2213-8587(19)30002-6\n10.1111/bcpt.13703\n10.1097/MD.0000000000004526\n10.1111/j.1471-0528.2006.01034.x\n10.1097/AOG.0000000000002698\n10.1001/jamanetworkopen.2020.11995\n10.1016/j.fertnstert.2017.06.026\n10.1002/14651858.CD006105.pub4\n10.1093/humrep/deg105\n10.1016/s0015-0282(00)01675-7\n10.1038/s41598-019-52263-w\n10.3945/ajcn.2010.29192\n10.1016/S0002-8223(99)00109-1\n10.1177/0890334418819465\n10.1016/s0002-9378(03)00828-7\n10.1055/s-0030-1269851\n10.2337/dc10-0819\n10.1007/s10995-012-0964-4\n10.1038/sj.ijo.0803741\n10.1111/j.1467-789X.2011.00971.x\n10.1111/1471-0528.12164\n10.1542/peds.2011-2583\n10.1097/FM9.0000000000000113\n10.1002/14651858.CD012037.pub2\n10.2337/dc11-0660\n10.1152/ajpendo.00586.2009\n10.1016/j.mehy.2009.05.036\n10.1136/bmjdrc-2017-000456\n10.1111/dom.14589\n10.1056/NEJMoa1509819\n10.1016/j.ajog.2020.01.054\n10.1016/S2352-4642(18)30385-7\n10.1186/s12887-020-1960-2\n10.1111/dme.14700\n10.1038/s41598-021-88650-5\n10.1186/s13063-022-06694",
    "journal": "Frontiers in endocrinology",
    "keywords": [
        "fertilization",
        "gestational diabetes",
        "insulin resistance",
        "metformin",
        "offspring",
        "pregnancy"
    ],
    "methods": null,
    "publication_date": "2023-07-06",
    "pubmed_id": "37409227\n17982337\n3292560\n31828161\n8134054\n33561645\n9408743\n22442298\n18463375\n31754898\n22144985\n35163187\n32897388\n18536788\n20118196\n34987051\n29973490\n18161398\n18463376\n21083860\n21679232\n23068960\n23020608\n23524173\n23724063\n31558075\n33887240\n29094444\n32946820\n26165398\n30528218\n32555996\n33008770\n15178665\n20926533\n23006146\n30792154\n34964262\n27603343\n16903840\n29995717\n32744629\n28865539\n33347618\n12571165\n11172832\n31690730\n20573792\n10207398\n30629889\n14710101\n21120793\n20573751\n22350633\n17938639\n22188548\n23418811\n22492772\n29103210\n21949222\n20570822\n19692185\n29682291\n34738701\n26840133\n32017923\n30704873\n32039724\n24070926\n34569082\n33927270\n36131291",
    "results": null,
    "title": "Lights and shadows on the use of metformin in pregnancy: from the preconception phase to breastfeeding and beyond.",
    "xml": "<Element 'PubmedArticle' at 0x788503e509a0>"
}