Hawthorne G
Newcastle Diabetes Centre, Newcastle General Hospital, Newcastle upon Tyne, UK.
Diabet Med. 2006 Mar;23(3):223-7. doi: 10.1111/j.1464-5491.2006.01856.x.
The prevalence of Type 2 diabetes in women of childbearing age continues to grow as the incidence of Type 2 diabetes increases. Recent evidence shows that treatment of gestational diabetes ensures the best possible outcome for pregnancy complicated by gestational diabetes. Metformin is a logical treatment in these circumstances but there has always been concern about its safety for the fetus, particularly as it crosses the placenta and it may increase the risk of teratogenesis. Although evidence is accumulating that metformin is useful and has a role in polycystic ovary syndrome, a condition of insulin resistance, it is not yet accepted as treatment for Type 2 diabetes in pregnancy and gestational diabetes. Observational data supports the use of metformin in Type 2 diabetes in pregnancy and its role in gestational diabetes is currently under investigation. Metformin may become an important treatment for women with either gestational or Type 2 diabetes in pregnancy and indeed may have additional important benefits for women, including reducing insulin resistance, body weight and long-term risk of diabetes. There is a need for a randomized controlled trial in women with Type 2 diabetes in pregnancy with long-term follow-up of both mothers and children. Until then the best advice remains that optimized glycaemic control prior to conception and during pregnancy is the most important intervention for best possible pregnancy outcome.
随着2型糖尿病发病率的上升，育龄女性中2型糖尿病的患病率持续增长。最近的证据表明，对妊娠期糖尿病进行治疗可确保妊娠合并妊娠期糖尿病获得最佳结局。在这种情况下，二甲双胍是一种合理的治疗药物，但人们一直担心其对胎儿的安全性，尤其是因为它可穿过胎盘，可能会增加致畸风险。尽管越来越多的证据表明二甲双胍对多囊卵巢综合征（一种胰岛素抵抗疾病）有用且有作用，但它尚未被接受用于治疗妊娠2型糖尿病和妊娠期糖尿病。观察性数据支持在妊娠2型糖尿病中使用二甲双胍，其在妊娠期糖尿病中的作用目前正在研究中。二甲双胍可能会成为患有妊娠期糖尿病或妊娠2型糖尿病女性的重要治疗药物，实际上可能对女性还有其他重要益处，包括降低胰岛素抵抗、体重以及糖尿病的长期风险。有必要对妊娠2型糖尿病女性进行随机对照试验，并对母亲和孩子进行长期随访。在此之前，最好的建议仍然是，在受孕前和孕期实现最佳血糖控制是获得最佳妊娠结局的最重要干预措施。
