Early Intervention for Gestational Diabetes

Gestational diabetes (GDM) represents a significant and growing source nationwide of
morbidity and mortality for both mothers and infants. Between 5 and 10% of pregnancies are
complicated by GDM. Infants exposed in utero to hyperglycemia from GDM have an increased
risk of neonatal complications as well as an increased prevalence of a number of chronic
diseases, including type 2 diabetes and schizophrenia. Recent research shows that treatment
with metformin begun as soon as hyperglycemia is detected in pregnancy is safe and
effective. Additional studies demonstrated that metformin is able to decrease the incidence
of type 2 diabetes among individuals at risk for this disease. Based upon these findings,
the investigators propose to test the hypothesis that metformin therapy for women at risk
for gestational diabetes, started prior to conception and before the onset of hyperglycemia,
both decreases the incidence of and improves the maternal and neonatal outcomes from GDM.

The investigators intend to conduct a prospective, randomized, double-blind placebo
controlled range-finding study to measure the effects of early metabolic intervention with
metformin in women at risk for GDM before the commencement of pregnancy or prior to
completion of the first trimester. The target sample size for this pilot study is 100
women. The effect size observed will provide preliminary data for a subsequent study which
will be sufficiently powered to detect small or moderate effects from early metabolic
intervention in women at risk for GDM.

The specific aims of the proposed research consist of the following:

1. Determine whether treating women at risk for GDM with metformin prior to conception
and/or completion of the 1st trimester decreases the incidence of GDM at 26 weeks'
gestation.

2. Evaluate the effects on maternal and fetal pregnancy outcomes of pre-conception
metabolic intervention with metformin in women at risk for GDM.

3. Use these pilot study results to:

1. identify specific demographic characteristics associated with an intervention
effect

2. calculate effect size for specific outcomes

3. provide range-finding data for a subsequent study design

Metformin therapy for women at risk for gestational diabetes, started prior to conception
and before the onset of hyperglycemia, both decreases the incidence of and improves the
maternal and neonatal outcomes from GDM.