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The study reported similar rate of cesarean delivery (range: 23%52%) and infant birth weights (MD: 93 g, 95% CI: 191 to 5 g), with no significant difference in maternal glycemic control between the treatments.[176] Furthermore, a systemic review and meta-analysis reported no significant difference in terms of glycemic control or pregnancy outcomes between GLIB and insulin when used during pregnancy.[177] Moreover, in a meta-analysis, no significant difference was observed in the rate of neonatal major abnormality or neonatal death among women treated with GLIB-metformin compared with nonexposed women during first trimester

Stress and Cortisol : Chronic stress elevates cortisol levels, which can interfere with GLP-1 sensitivity and metabolic function

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The result may be more dramatic than either stressor would cause alone