Table 2.
Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) summary of neonatal outcomes of meta-analysis
| Metformin vs. insulin for gestational diabetes mellitus Patient population: patients with gestational diabetes mellitus Intervention: metformin Comparison: insulin | ||||||
|---|---|---|---|---|---|---|
| Outcomes | Anticipated absolute effects | RR/SMD (95%CI) | No. of Participants (Studies) |
Certainty of the evidence (GRADE) | Comments | |
| Risk with Insulin | Risk with Metformin | |||||
| Birthweight |
SMD -0.33 (-0.5 to -0.17) |
4174 (22 RCTs) |
⨁⨁◯◯ Low |
Most of researches have limitations in methodology Unexplained heterogeneity |
||
| Macrosomia | 137 per 1,000 | 93 per 1,000 |
RR 0.68 (0.54 to 0.86) |
3484 (20 RCTs) |
⨁⨁⨁◯ Moderate |
Researches have limitations in methodology |
| LGA | 188 per 1,000 | 162 per 1,000 |
RR 0.86 (0.73 to 1.02) |
2843 (12 RCTs) |
⨁⨁⨁◯ Moderate |
Most of researches have limitations in methodology |
| SGA | 75 per 1,000 | 75 per 1,000 |
RR 1.00 (0.77 to 1.30) |
2812 (12 RCTs) |
⨁⨁◯◯ Low |
Most of researches have limitations in methodology Unexplained heterogeneity |
| Birth Height |
SMD -0.09 (-0.27 to -0.08) |
1084 (3 RCTs) |
⨁◯◯◯ Very low |
Researches have limitations in methodology Very few RCTs lead to imprecision of estimate Unexplained heterogeneity |
||
| NICU admission | 207 per 1000 | 151 per 1000 |
RR 0.73 (0.61 to 0.88) |
3527 (18 RCTs) |
⨁⨁⨁◯ Moderate |
Most of researches have limitations in methodology |
| Hypoglycemia | 164 per 1000 | 107 per 1000 |
RR 0.65 (0.54 to 0.84) |
3670 (20 RCTs) |
⨁⨁◯◯ Low |
Most of researches have limitations in methodology 2. There is a possibility of publication bias in these studies |
GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of the effect
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of the effect and may change the estimate
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of the effect and is likely to change the estimate
Very low quality: We are very uncertain about the estimate
RCTs Randomized controlled trials; CI confidence interval; RR risk ratio; SMD Std mean difference