Servei d'Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBER-BBN, Madrid, Spain.
Servei d'Endocrinologia i Nutrició, Hospital de la Mútua de Terrassa, Terrassa, Spain.
Diabetes Res Clin Pract. 2018 Nov;145:51-58. doi: 10.1016/j.diabres.2018.04.015. Epub 2018 Apr 19.
Diabetes is a frequent condition in pregnancy and achieving adequate glycemic control is of paramount importance. Insulin treatment is the gold standard, oral agents are more attractive, but their safety and efficiency should be a prerequisite for their use. We have more information regarding treatment of women with gestational diabetes mellitus where glyburide can induce a picture of fetal hyperinsulinism (higher birthweight and more neonatal hypoglycemia) whereas metformin requires supplemental insulin in a larger proportion of women but achieves satisfactory perinatal outcomes with the exception of preterm birth. Information in patients with Type 2 Diabetes Mellitus is much more limited but also favors metformin. Combinations provide additional possibilities. However, as to long-term outcomes, we have no information on the impact of exposure to glyburide and it is still unclear if in utero exposure to metformin will have any effect on the offspring and the direction of this effect. Women prefer oral agents, indicating the need of additional studies.
糖尿病是妊娠中常见的病症，实现良好的血糖控制至关重要。胰岛素治疗是金标准，口服药物更具吸引力，但在使用之前，应先确保其安全性和有效性。我们对患有妊娠糖尿病的女性的治疗有更多信息，其中格列本脲可导致胎儿高胰岛素血症（出生体重更高，新生儿低血糖更多），而二甲双胍则需要更多女性补充胰岛素，但除早产外，可实现满意的围产期结局。关于 2 型糖尿病患者的信息要有限得多，但也倾向于使用二甲双胍。联合用药提供了更多的可能性。然而，就长期结局而言，我们没有格列本脲暴露的影响的信息，也不清楚胎儿暴露于二甲双胍是否会对后代产生任何影响，以及这种影响的方向。女性更喜欢口服药物，这表明需要进行更多的研究。
