Holt R I G, Lambert K D
Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
Diabet Med. 2014 Mar;31(3):282-91. doi: 10.1111/dme.12376.
While insulin has been the treatment of choice when lifestyle measures do not maintain glycaemic control during pregnancy, recent studies have suggested that certain oral hypoglycaemic agents may be safe and acceptable alternatives. With the exception of metformin and glibenclamide (glyburide), there are insufficient data to recommend treatment with any other oral hypoglycaemic agent during pregnancy. There are no serious safety concerns with metformin, despite it crossing the placenta. When used in the first trimester, there is no increase in congenital abnormalities and there appears to be a reduction in miscarriage, pre-eclampsia and subsequent gestational diabetes. Studies of the use of metformin in gestational diabetes show at least equivalent neonatal outcomes, while reporting reductions in neonatal hypoglycaemia, maternal hypoglycaemia and weight gain and improved treatment satisfaction. Glibenclamide effectively lowers blood glucose in women with gestational diabetes, possibly with a lower treatment failure rate than metformin. Although generally well tolerated, some studies have reported higher rates of pre-eclampsia, neonatal jaundice, longer stay in the neonatal care unit, macrosomia and neonatal hypoglycaemia. There is a paucity of long-term follow-up data on children exposed to oral agents in utero. The American College of Obstetrics and Gynecology and the UK National Institute of Health and Care Excellence (NICE) have recommended that either metformin or glibenclamide can be used to treat gestational diabetes. Metformin is also recommended for use in the pre-conception period by NICE. By contrast, the American Diabetes Association recommends that both drugs should only be used during pregnancy in the context of clinical trials.
虽然当生活方式干预措施无法在孕期维持血糖控制时，胰岛素一直是首选治疗药物，但最近的研究表明，某些口服降糖药可能是安全且可接受的替代药物。除二甲双胍和格列本脲（优降糖）外，尚无足够数据推荐在孕期使用其他任何口服降糖药进行治疗。尽管二甲双胍可穿过胎盘，但并无严重安全问题。在孕早期使用时，先天性异常并无增加，且流产、先兆子痫及后续妊娠糖尿病的发生率似乎有所降低。关于二甲双胍用于妊娠糖尿病的研究表明，其新生儿结局至少相当，同时报告显示新生儿低血糖、母亲低血糖及体重增加减少，治疗满意度提高。格列本脲可有效降低妊娠糖尿病女性的血糖，其治疗失败率可能低于二甲双胍。尽管总体耐受性良好，但一些研究报告称先兆子痫、新生儿黄疸、新生儿重症监护病房住院时间延长、巨大儿及新生儿低血糖的发生率较高。对于子宫内接触口服药物的儿童，长期随访数据较少。美国妇产科学会和英国国家卫生与临床优化研究所（NICE）建议，二甲双胍或格列本脲均可用于治疗妊娠糖尿病。NICE还建议在孕前使用二甲双胍。相比之下，美国糖尿病协会建议，这两种药物仅应在临床试验背景下用于孕期。
