Department of Endocrinology, Specialized Hospital for Active Treatment of Obstetrics and Gynaecology "Dr Shterev", Sofia, Bulgaria, Bulgaria.
Department of Pharmaceutical Sciences, Faculty of Pharmacy, Medical University of Plovdiv, Bulgaria.
Ginekol Pol. 2024;95(4):259-265. doi: 10.5603/gpl.91632. Epub 2023 Oct 16.
To assess the maternal and neonatal outcomes in women with GDM treated with metformin, medical nutrition therapy (MNT) or insulin.
The current retrospective cohort study includes data from 233 women diagnosed with GDM who gave birth between January 2017 and January 2019 at an obstetrics and gynecology hospital in Sofia, Bulgaria. Patients were assigned to three groups, according to the treatment approach - metformin group (n = 70), insulin group (n = 40), and MNT group (n = 123). Values of fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) have been evaluated at diagnosis of GDM and the third trimester of pregnancy. A comparative analysis of pregnancy outcomes and short-term neonatal characteristics in the investigated groups has been performed.
Women indicated for pharmacological treatment (metformin or insulin) had significantly higher BMI (p < 0.01), FPG (p < 0.001), and HbA1c levels (p < 0.001) at baseline. However, during pregnancy, patients treated with metformin showed a significantly lower BMI (p < 0.01), FPG (p < 0.01), and HbA1c (p < 0.01). Neonates born to metformin-treated mothers had lower birth weight compared to those born to women in the MNT and insulin groups (metformin vs MNT, p < 0.001; metformin vs insulin, p = 0.03). The lowest incidence of newborns with macrosomia and neonatal hypoglycemia has been observed in the metformin cohort. Not a single newborn with an Apgar score under 7 has been identified in the metformin group.
According to the current analysis, women with GDM treated with metformin demonstrated better maternal and neonatal outcomes. No short-term complications in newborns have been associated with metformin use during pregnancy.
评估使用二甲双胍、医学营养疗法（MNT）或胰岛素治疗的 GDM 妇女的母婴结局。
本回顾性队列研究纳入了 2017 年 1 月至 2019 年 1 月期间在保加利亚索非亚一家妇产科医院分娩的 233 名 GDM 患者的数据。根据治疗方法将患者分为三组：二甲双胍组（n = 70）、胰岛素组（n = 40）和 MNT 组（n = 123）。在 GDM 诊断时和妊娠晚期评估空腹血浆葡萄糖（FPG）和糖化血红蛋白（HbA1c）的值。对研究组的妊娠结局和短期新生儿特征进行了比较分析。
需要药物治疗（二甲双胍或胰岛素）的女性在基线时的 BMI（p < 0.01）、FPG（p < 0.001）和 HbA1c 水平（p < 0.001）显著更高。然而，在怀孕期间，接受二甲双胍治疗的患者 BMI（p < 0.01）、FPG（p < 0.01）和 HbA1c（p < 0.01）均显著降低。与 MNT 组和胰岛素组相比，接受二甲双胍治疗的母亲所生新生儿的出生体重较低（二甲双胍与 MNT 相比，p < 0.001；二甲双胍与胰岛素相比，p = 0.03）。二甲双胍组新生儿巨大儿和新生儿低血糖的发生率最低。在二甲双胍组中未发现新生儿 Apgar 评分低于 7 的情况。
根据目前的分析，使用二甲双胍治疗的 GDM 妇女表现出更好的母婴结局。在怀孕期间使用二甲双胍与新生儿的任何短期并发症无关。
