Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
PLoS One. 2013 May 27;8(5):e64585. doi: 10.1371/journal.pone.0064585. Print 2013.
Nowadays, there have been increasing studies comparing metformin with insulin. But the use of metformin in pregnant women is still controversial, therefore, we aim to examine the efficiency and safety of metformin by conducting a meta-analysis of randomized controlled trials (RCTs) comparing the effects of metformin with insulin on glycemic control, maternal and neonatal outcomes in gestational diabetes mellitus (GDM).
We used the key words "gestational diabetes" in combination with "metformin" and searched the databases including Pubmed, the Cochrane Library, Web of knowledge, and Clinical Trial Registries. A random-effects model was used to compute the summary risk estimates.
Meta-analysis of 5 RCTs involving 1270 participants detected that average weight gains after enrollment were much lower in the metformin group (n = 1006, P = 0.003, SMD = -0.47, 95%CI [-0.77 to -0.16]); average gestational ages at delivery were significantly lower in the metformin group (n = 1270, P = 0.02, SMD = -0.14, 95%CI [-0.25 to -0.03]); incidence of preterm birth was significantly more in metformin group (n = 1110, P = 0.01, OR = 1.74, 95%CI [1.13 to 2.68]); the incidence of pregnancy induced hypertension was significantly less in the metformin group (n = 1110, P = 0.02, OR = 0.52, 95%CI [0.30 to 0.90]). The fasting blood sugar levels of OGTT were significantly lower in the metformin only group than in the supplemental insulin group (n = 478, P = 0.0006, SMD = -0.83, 95%CI [-1.31 to -0.36]).
Metformin is comparable with insulin in glycemic control and neonatal outcomes. It might be more suitable for women with mild GDM. This meta-analysis also provides some significant benefits and risks of the use of metformin in GDM and help to inform further development of management guidelines.
如今，越来越多的研究比较了二甲双胍和胰岛素。然而，在孕妇中使用二甲双胍仍存在争议，因此，我们旨在通过对比较二甲双胍和胰岛素对妊娠期糖尿病（GDM）患者血糖控制、母婴结局影响的随机对照试验（RCT）进行荟萃分析来评估二甲双胍的疗效和安全性。
我们使用了“gestational diabetes”和“metformin”这两个关键词，并检索了包括 Pubmed、Cochrane Library、Web of knowledge 和 Clinical Trial Registries 在内的数据库。使用随机效应模型计算汇总风险估计值。
对 5 项纳入 1270 名参与者的 RCT 的荟萃分析显示，二甲双胍组（n=1006）的平均体重增加量显著低于胰岛素组（P=0.003，SMD=-0.47，95%CI [-0.77 至-0.16]）；二甲双胍组的平均分娩孕周显著低于胰岛素组（n=1270，P=0.02，SMD=-0.14，95%CI [-0.25 至-0.03]）；二甲双胍组早产发生率显著高于胰岛素组（n=1110，P=0.01，OR=1.74，95%CI [1.13 至 2.68]）；二甲双胍组妊娠高血压发生率显著低于胰岛素组（n=1110，P=0.02，OR=0.52，95%CI [0.30 至 0.90]）。与胰岛素组相比，仅使用二甲双胍组的 OGTT 空腹血糖水平显著降低（n=478，P=0.0006，SMD=-0.83，95%CI [-1.31 至-0.36]）。
在血糖控制和新生儿结局方面，二甲双胍与胰岛素相当。它可能更适合轻度 GDM 患者。这项荟萃分析还提供了使用二甲双胍治疗 GDM 的一些重要益处和风险，有助于进一步制定管理指南。
