Metformin Plus Insulin for Preexisting Diabetes or Gestational Diabetes in Early Pregnancy

( JAMA . 2023;330(22):2182–2190. doi:10.1001/jama.2023.22949) Higher risks are associated with pregnancies in which the mother has a diagnosis of diabetes, whether preexisting type 2 diabetes mellitus (T2DM) or gestational diabetes diagnosed before 23 weeks gestation (EgD). Management of maternal diabetes is the best way to limit adverse pregnancy and birth outcomes for both mother and child and includes blood glucose monitoring, dietary modification, and insulin therapy to optimize glycemic control. This study tested the impact of adding metformin to insulin therapy on the risk of adverse neonatal outcomes. The Medical Optimization of Management of Overt Type 2 Diabetes in Pregnancy, hereafter referred to as the MOMPOD trial, implemented at 17 clinical U.S. sites, utilized a randomized, double-blinded, placebo-controlled protocol. Participants were pregnant between June 2017 and November 2021, aged 18 to 45 years, with singleton gestation pregnancies in the 10 to 22 weeks 6 days range and a diagnosis of T2DM or EgD requiring insulin therapy.