Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China.
Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, China.
J Matern Fetal Neonatal Med. 2024 Dec;37(1):2295809. doi: 10.1080/14767058.2023.2295809. Epub 2023 Dec 20.
The use of metformin for treating gestational diabetes mellitus (GDM) remains controversial because it can pass through the placenta. This meta-analysis aimed to compare the effects of metformin and insulin on maternal and neonatal outcomes in patients with GDM.
We conducted a comprehensive search of the PubMed, Embase, and Cochrane Library databases, focusing on randomized controlled trials (RCTs) that evaluated the impacts of metformin and insulin on both maternal and neonatal outcomes in patients with GDM.
Twenty-four RCTs involving 4934 patients with GDM were included in this meta-analysis. Compared with insulin, metformin demonstrated a significant reduction in the risks of preeclampsia (RR 0.61, 95% CI 0.48 to 0.78, < .0001), induction of labor (RR 0.90, 95% CI 0.82 to 0.98, = .02), cesarean delivery (RR 0.91, 95% CI 0.85 to 0.98, = .01), macrosomia (RR 0.67, 95% CI 0.53 to 0.83, = .0004), neonatal intensive care unit (NICU) admission (RR 0.75, 95% CI 0.66 to 0.86, < .0001), neonatal hypoglycemia (RR 0.55, 95% CI 0.48 to 0.63, < .00001), and large for gestational age (LGA) (RR 0.80, 95% CI 0.68 to 0.94, = .007). Conversely, metformin showed no significant impact on gestational hypertension (RR 0.84, 95% CI 0.67 to 1.06, = .15), spontaneous vaginal delivery (RR 1.13, 95% CI 1.00 to 1.08, = .05), emergency cesarean section (RR 0.94, 95% CI 0.77 to 1.16, = .58), shoulder dystocia (RR 0.65, 95% CI 0.31 to 1.39, = .27), premature birth (RR 0. 92, 95% CI 0.61 to 1.39, = .69), polyhydramnios (RR 1.11, 95% CI 0.54 to 2.30, = .77), birth trauma (RR 0.87, 95% CI 0.54 to 1.39, = .56), 5-min Apgar score < 7 (RR 1.13, 95% CI 0.76 to 1.68, = .55), small for gestational age (SGA) (RR 0.93, 95% CI 0.71 to 1.22, = .62), respiratory distress syndrome (RDS) (RR 0.74, 95% CI 0.50 to 1.08, = .11), jaundice (RR 1.09, 95% CI 0.95 to 1.25, = .24) or birth defects (RR 0.80, 95% CI 0.37 to 1.74, = .57).
The findings suggest that metformin can reduce the risk of certain maternal and neonatal outcomes compared with insulin therapy for GDM. However, long-term follow-up studies of patients with GDM taking metformin and their offspring are warranted to provide further evidence.
二甲双胍用于治疗妊娠期糖尿病（GDM）仍然存在争议，因为它可以穿过胎盘。本荟萃分析旨在比较二甲双胍和胰岛素对 GDM 患者的母婴结局的影响。
我们对 PubMed、Embase 和 Cochrane Library 数据库进行了全面检索，重点关注评估二甲双胍和胰岛素对 GDM 患者的母婴结局影响的随机对照试验（RCT）。
共有 24 项 RCT 纳入了 4934 名 GDM 患者，纳入了本荟萃分析。与胰岛素相比，二甲双胍可显著降低子痫前期（RR 0.61，95%CI 0.48 至 0.78， < .0001）、引产（RR 0.90，95%CI 0.82 至 0.98， = .02）、剖宫产（RR 0.91，95%CI 0.85 至 0.98， = .01）、巨大儿（RR 0.67，95%CI 0.53 至 0.83， = .0004）、新生儿重症监护病房（NICU）入院（RR 0.75，95%CI 0.66 至 0.86， < .0001）、新生儿低血糖（RR 0.55，95%CI 0.48 至 0.63， < .00001）和巨大儿（RR 0.80，95%CI 0.68 至 0.94， = .007）的风险。相反，二甲双胍对妊娠高血压（RR 0.84，95%CI 0.67 至 1.06， = .15）、自然分娩（RR 1.13，95%CI 1.00 至 1.08， = .05）、紧急剖宫产（RR 0.94，95%CI 0.77 至 1.16， = .58）、肩难产（RR 0.65，95%CI 0.31 至 1.39， = .27）、早产（RR 0.92，95%CI 0.61 至 1.39， = .69）、羊水过多（RR 1.11，95%CI 0.54 至 2.30， = .77）、产伤（RR 0.87，95%CI 0.54 至 1.39， = .56）、5 分钟 Apgar 评分<7（RR 1.13，95%CI 0.76 至 1.68， = .55）、小于胎龄儿（SGA）（RR 0.93，95%CI 0.71 至 1.22， = .62）、呼吸窘迫综合征（RDS）（RR 0.74，95%CI 0.50 至 1.08， = .11）、黄疸（RR 1.09，95%CI 0.95 至 1.25， = .24）或出生缺陷（RR 0.80，95%CI 0.37 至 1.74， = .57）的风险无显著差异。
研究结果表明，与胰岛素治疗相比，二甲双胍可降低 GDM 患者某些母婴结局的风险。然而，需要对服用二甲双胍的 GDM 患者及其后代进行长期随访研究，以提供进一步的证据。
