***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Please cite this paper as : Ijäs H , Vääräsmäki M , Morin‐Papunen L , Keravuo R , Ebeling T , Saarela T , Raudaskoski T. Metformin should be considered in the treatment of gestational diabetes : a prospect i ve r and omised study . BJOG 2011;118:880–885 AIM To compare treatment with metformin alone , metformin plus insulin and insulin alone in women with gestational diabetes ( GDM ) . METHOD A total of 150 gestational diabetic patients who fulfilled the eligibility criteria were included in this prospect i ve r and omized control open labeled study . A risk factor based screening was done followed by a GCT and then local GTT criteria from antenatal clinics . They were initially divided into two groups with odd numbers assigned to metformin treatment and even numbers to insulin treatment . Metformin and /or insulin treatment was given and target blood sugar levels aim ed at FBS ≤ 100 mg/dl and postpr and ial levels ≤ 126 mg/dl . Supplemental insulin was added to metformin treatment group to maintain the glycemic targets if required . Patients were followed until delivery and maternal fetal outcomes and pharmacotherapeutic characteristics were recorded on a performa . RESULTS Less maternal weight gain was found in the metformin treated groups ( 9.8 ± 1.5 kg [ metformin alone ] vs. 9.8 ± 1.4 kg [ metformin plus insulin ] vs. 12.5 ± 1.1 kg [ insulin alone ] P < 0.000 ) . Preeclampsia was significantly less in metformin treated groups . There were no perinatal deaths in the study . Mean birth weight was significantly less in metformin treated groups ( 3.4 ± 0.4 kg vs. 3.3 ± 0.5 kg vs. 3.7 ± 0.5 kg P < 0.01 ) . Less neonatal morbidity was observed in metformin groups . 42.7 % of patients required supplemental insulin ( mean dose of 13.6 ± 2 units ) in the  metformin group . Mean gestational age at which insulin was added was 31.8 ± 5.9 weeks . CONCLUSION Metformin is an effective and cheap treatment option for women with gestational diabetes with or without supplemental insulin OBJECTIVE Few studies support oral diabetic treatment in pregnant women with type 2 diabetes mellitus ( T2DM ) . The objective of this study was to compare the effects of metformin versus insulin on achieving glycemic control and improving maternal and neonatal outcomes in pregnant women with T2DM . STUDY DESIGN A pilot r and omized , controlled trial was conducted of metformin versus insulin for the treatment of T2DM during pregnancy . The primary outcome was glycemic control measured with hemoglobin A1c < 7 % at delivery . Maternal and neonatal outcomes were compared between groups . RESULTS In this study , 8 women received metformin and 11 received insulin .  All women in both groups achieved glycemic control by delivery ( HgbA1c : metformin 5.96 ± 5.88 vs. insulin 6.34 ± 0.92 % ) . There were similar rates of cesarean delivery , birth weights , neonatal intensive care unit admissions , respiratory distress syndrome , and neonatal dextrose treatment between groups . There was one case of fetal macrosomia in the insulin group , one case of shoulder dystocia in the metformin group and no cases of failed metformin therapy . CONCLUSION In this pilot study , glycemic control was achieved in women who received metformin and insulin . Larger studies are needed to determine whether metformin can be considered a reasonable alternative to insulin in pregnant women with T2DM AIMS We compared metformin with insulin as treatment of gestational diabetes mellitus ( GDM ) . Furthermore , we aim ed to characterize  metformin-treated patients needing additional insulin to achieve prespecified glucose targets . METHODS We conducted a single centre r and omized controlled study with non-inferiority design comparing metformin and insulin in the treatment of 217 GDM patients having birth weight as primary outcome variable . RESULTS There were no significant differences in mean birth weight expressed in grams [ + 15 ( 90 % confidence interval ( CI ) : -121 to 89 ) ] or SD units [ + 0.04 ( 90 % CI : -0.27 to 0.18 ) ] between the metformin and insulin groups . There were no significant differences in neonatal or maternal data between the groups . Only 23 ( 20.9 % ) of the 110 patients in the metformin group needed additional insulin .  Compared with the patients on metformin only , those needing additional insulin  were older ( p = 0.04 ) , their oral glucose tolerance test had been performed earlier and diabetes therapy started earlier in gestation ( p = 0.01 and p = 0.004 , respectively ) . The risk for additional insulin was 4.6-fold in women with baseline serum fructosamine concentration above median compared with those below median . CONCLUSIONS Metformin is an effective alternative to insulin in the treatment of GDM patients . Serum fructosamine may help in predicting the adequacy of metformin treatment alone OBJECTIVE To compare glycemic control and neonatal outcomes in women with gestational diabetes mellitus ( GDM ) treated with metformin vs. insulin . STUDY DESIGN Women with GDM not controlled with diet and exercise were r and omized to metformin ( n = 32 ) or insulin ( n = 31 ) . The levels of glycemic control as well as maternal/neonatal complications were evaluated . RESULTS The mean ( + /- SD ) fasting and 2-hour postpr and ial blood glucose did not differ statistically between the 2 treatment groups . No patient failed metformin and required insulin . The majority ( 27/32 ) were easily controlled on the initial dosage ( 500 mg twice a day ) . Gestational age at entry and delivery ( p = 0.077 , 0.412 ) were similar . The difference in the rate of cesarean delivery was not statistically significant between the 2 groups ( p = 0.102 ) . Neonatal statistics were also not different between the metformin and insulin groups : birth weight , Apgar score at 5 minutes , respiratory distress syndrome , hyperbilirubinemia , neonatal hypoglycemia and neonatal intensive care unit admission ( p = 0.144 - 0.373 ) . CONCLUSION Based on these preliminary data , metformin appears to be an effective alternative to insulin in the treatment of GDM Background : Few studies have been done on the use of metformin in pregnancy and their results were not similar , therefore this research is performed to compare neonatal outcomes of metformin and insulin in the treatment of gestational diabetes . Methods : In this prospect i ve r and omized trial , 200 pregnant women within their 24th to 34th weeks of gestation with gestational diabetes , single fetus pregnancy , and in need of hyperglycemia treatment were entered and grouped as either metformin or insulin . Data related to maternal and neonatal outcomes were recorded and analyzed . Results : Considering data recorded of HbA1c at the beginning of pregnancy , pregnancy induced hypertension , preeclampsia , birth weight , dystocia , first and 5th min APGAR , neonatal sepsis , rout of delivery , liver function tests of neonate , hypoglycemia , anomaly , and still birth , there were no significant statistical differences between groups . The end pregnancy HbA1c , maternal weight gain during pregnancy , preterm labor , neonatal jaundice , respiratory distress and hospitalization of infants were higher in insulin group . Conclusions : Considering data from this study , metformin is efficient to control hyperglycemia in pregnancy . It is suggested performing more studies to evaluate long term side effects of metformin in pregnancy with higher sample size and longer follow-up of newborns BACKGROUND : The impact of metformin medication in pregnant women with polycystic ovary syndrome on weight gain during pregnancy and after delivery and the impact on growth of the offspring are essentially unexplored . METHODS : This is a follow-up study of a r and omized controlled trial ( The Metformin treatment in pregnant PCOS women study ) , conducted in 11 secondary care centers . Women with PCOS were r and omized to metformin ( 2000 mg daily ) or placebo from first trimester to delivery . Question naires were sent to 256 participants 1 year postpartum .  Maternal weight development in pregnancy and the first year after delivery and offspring anthropometry at birth and weight 1 year postpartum were registered . RESULTS : Women r and omized to metformin  gained less weight during pregnancy compared with those in the placebo group . In the newborns , there was no difference between the 2 groups in weight or length . One year postpartum , women who used metformin in pregnancy lost less weight and their infants were heavier than those in the placebo group ( 10.2 ± 1.2 kg vs 9.7 ± 1.1 kg , P = .003 ) . CONCLUSIONS : Women r and omized to metformin were heavier in the first trimester , gained less weight in pregnancy , and lost less weight in the first year postpartum compared with women r and omized to placebo . Children exposed to metformin weighed more at 1 year of age Background : The objective of this study was to compare neonatal outcomes in women with gestational diabetes mellitus ( GDM ) treated with either metformin or insulin . Material s and Methods : A r and omized clinical trial carried out on year 2011 on 109 women with GDM who did not adequately control by dietary measures . They received metformin 500 mg once or twice daily or insulin 0.2 IU/kg/day initially . The dose was titrated to achieve target blood glucose values . Neonatal outcomes such as hypoglycemia , birth weight , Apgar score , umbilical artery pH , and hyperbilirubinemia in the 50 women who remained exclusively on metformin  were compared with 50 women who treated with insulin .  Results : Two groups were similar in mean fasting blood sugar ( P = 0.7 ) and postpr and ial measurements ( P = 0.8 ) throughout GDM treatment . Pregnancy complications or preterm labor were not different significantly between two groups . Considering neonatal outcomes between insulin and metformin groups , such as hypoglycemia ( 2 [ 4 % ] and 0 [ 0 % ] , respectively ) , birth weight ( 3342 ± 506 mg and 3176 ± 438 mg , respectively ) , 5th min Apgar score < 7 ( no one in either group ) , umbilical artery pH < 7.05 ( no one in either group ) and hyperbilirubinemia ( 1 [ 2 % ] and 0 [ 0 % ] , respectively ) , no significant statistical differences were seen . Conclusion : Based on these preliminary data , considering neonatal outcomes , metformin appears to be a safe as  insulin in the treatment of GDM To compare the growth and development of children born to mothers with gestational diabetes mellitus ( GDM ) requiring pharmacological treatment , and r and omised to treatment with metformin or insulin Purpose The aim of the present study is to assess the impact of adding oral metformin to insulin therapy in pregnant women with insulin-resistant diabetes mellitus . Methods The current non-inferiority r and omized controlled trial was conducted at Ain Shams University Maternity Hospital . The study included pregnant women with gestational or pre-existing diabetes mellitus at gestations between 20 and 34 weeks , who showed insulin resistance ( defined as poor glycemic control at a daily dose of ≥1.12 units/kg ) . Recruited women were r and omized into one of two groups : group I , including women who received oral metformin without increasing the insulin dose ; and group II , including women who had their insulin dose increased . The primary outcome was maternal glycemic control . Secondary outcomes included maternal bouts of hypoglycemia , need for another hospital admission for uncontrolled diabetes during pregnancy , gestational age at delivery , mode of delivery , birth weight , birth trauma , congenital anomalies , 1- and 5-min Apgar score , neonatal hypoglycemia , need for neonatal intensive care unit ( NICU ) admission and adverse neonatal outcomes . Results A total number of 154 women with diabetes mellitus with pregnancy were approached ; of them 90 women were eligible and were r and omly allocated and included in the final analysis . The recruited 90 women were r and omized into one of two groups : group I ( metformin group ) ( n = 46 ) , including women who received oral metformin in addition to the same initial insulin dose ; and group II ( control group ) ( n = 44 ) , including women who had their insulin dose increased according to the st and ard protocol . The mean age of included women was 29.84 ± 5.37 years ( range 20–42 years ) . The mean gestational age at recruitment was 28.7 ± 3.71 weeks ( range 21–34 weeks ) . Among the 46 women of group I , 
    Output:
    
Our review found that metformin had no short-term adverse effects on pregnancy , potential benefits in the neonatal period , but limited long-term follow-up information .