Ouyang Hong, Wu Na
Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China.
Clinical Skills Practice Teaching Center, Shengjing Hospital of China Medical University, Shenyang, China.
Diabetes Ther. 2021 Oct;12(10):2715-2753. doi: 10.1007/s13300-021-01142-7. Epub 2021 Sep 4.
A network meta-analysis was conducted to compare and rank the effects of different glucose-lowering measures on maternal and infant outcomes in pregnant women with gestational diabetes mellitus (GDM).
We searched the PubMed, CNKI, Embase, Cochrane Library, Wanfang, and Weipu databases for relevant studies published between database establishment and June 2021. Study retrieval involved subject-heading and keyword searches. Randomized controlled trials (RCTs) with different glucose-lowering treatments for GDM patients were included. The Cochrane tool was used to assess bias risk. Pairwise and network meta-analyses were used to compare and rank the effects of different hypoglycemic measures on maternal and infant outcomes in pregnant women with GDM.
We included 41 RCTs involving 6245 pregnant women with GDM. Patients treated with insulin had a higher incidence of neonatal intensive care unit (NICU) occupancy (1.3, 95% CI 1.0-1.7) than those treated with metformin. The insulin (1.5, 95% CI 1.1-2.1 and 1.8, 95% CI 1.0-3.3) and glyburide (2.0, 95% CI 1.2-3.2 and 2.5, 95% CI 1.1-8.4) groups exhibited higher incidences of neonatal hypoglycemia and large for gestational age (LGA) newborns than the metformin group. The glyburide group exhibited a lower probability of cesarean section than the metformin (0.76, 95% CI 0.55-1.0) and insulin (0.71, 95% CI 0.52-0.96) groups. Preeclampsia incidence in the diet and exercise groups was significantly lower than in the metformin (0.19, 95% CI 0.043-0.72) and insulin (0.15, 95% CI 0.032-0.52) groups. No intervention significantly reduced the incidences of macrosomia, preterm birth, gestational hypertension, or respiratory distress syndrome (RDS). The ranking results showed that the metformin group had the lowest rates of neonatal hypoglycemia, macrosomia, LGA, and NICU occupancy. The glyburide group had the lowest NICU occupancy and cesarean section rates and the highest neonatal hypoglycemia, LGA, preeclampsia, and gestational hypertension rates. The diet and exercise group had the lowest preterm delivery and preeclampsia rates and the highest NICU occupancy rate.
Metformin is a potentially superior choice for GDM treatment because it is associated with minimal incidences of multiple adverse pregnancy outcome indicators and does not lead to high values of certain adverse outcome indices. Other hypoglycemic agent or diet groups exhibit high incidences of certain adverse outcomes. Therefore, when selecting a GDM treatment strategy, the efficacies and risks of different treatment programs should be evaluated according to the scenario in hand.
进行了一项网状Meta分析，以比较和排序不同降糖措施对妊娠期糖尿病（GDM）孕妇母婴结局的影响。
我们检索了PubMed、CNKI、Embase、Cochrane图书馆、万方和维普数据库，查找在数据库建立至2021年6月期间发表的相关研究。研究检索涉及主题词和关键词搜索。纳入了对GDM患者采用不同降糖治疗的随机对照试验（RCT）。使用Cochrane工具评估偏倚风险。采用成对和网状Meta分析来比较和排序不同降糖措施对GDM孕妇母婴结局的影响。
我们纳入了41项RCT，涉及6245例GDM孕妇。接受胰岛素治疗的患者入住新生儿重症监护病房（NICU）的发生率（1.3，95%CI 1.0 - 1.7）高于接受二甲双胍治疗的患者。胰岛素组（1.5，95%CI 1.1 - 2.1和1.8，95%CI 1.0 - 3.3）和格列本脲组（2.0，95%CI 1.2 - 3.2和2.5，95%CI 1.1 - 8.4）的新生儿低血糖和大于胎龄（LGA）新生儿的发生率高于二甲双胍组。格列本脲组剖宫产的概率低于二甲双胍组（0.76，95%CI 0.55 - 1.0）和胰岛素组（0.71，95%CI 0.52 - 0.96）。饮食和运动组的子痫前期发生率显著低于二甲双胍组（0.19，95%CI 0.043 - 0.72）和胰岛素组（0.15，95%CI 0.032 - 0.52）。没有干预措施能显著降低巨大儿、早产、妊娠期高血压或呼吸窘迫综合征（RDS）的发生率。排序结果显示，二甲双胍组新生儿低血糖、巨大儿、LGA和入住NICU的发生率最低。格列本脲组入住NICU和剖宫产率最低，但新生儿低血糖、LGA、子痫前期和妊娠期高血压发生率最高。饮食和运动组早产和子痫前期发生率最低，但入住NICU率最高。
二甲双胍是GDM治疗的一个潜在更佳选择，因为它与多种不良妊娠结局指标的最低发生率相关，且不会导致某些不良结局指标的高值。其他降糖药物或饮食组某些不良结局的发生率较高。因此，在选择GDM治疗策略时，应根据具体情况评估不同治疗方案的疗效和风险。
