Department of Endocrinology, Center for Endocrinology, Diabetes, Arthritis & Rheumatism Superspeciality Healthcare, Dwarka, New Delhi, India.
Department of Rheumatology, Center for Endocrinology, Diabetes, Arthritis & Rheumatism Superspeciality Healthcare, Dwarka, New Delhi, India.
Endocr Pract. 2024 Sep;30(9):854-862. doi: 10.1016/j.eprac.2024.05.017. Epub 2024 Jun 12.
Data are scant on the impact of metformin use in gestational diabetes mellitus/diabetes in pregnancy on long-term outcomes in children and mothers beyond 5 years of childbirth. This systematic review and meta-analysis aimed to evaluate the long-term impact of metformin use in pregnancy on children and their mothers.
Electronic databases were searched for studies evaluating metformin compared with insulin for managing gestational diabetes mellitus/diabetes in pregnancy. The primary outcome was the change in body mass index (BMI) in children at the ages of 5 to 11 years. The secondary outcomes were alterations in other anthropometric measures, obesity, and changes in the levels of lipids and adipocytokines in children and mothers.
Children at the age of 9 years born to mothers who were treated with metformin during pregnancy had similar BMI (mean difference [MD], 1.09 kg/m [95% confidence interval {CI}, -0.44 to 2.62]; P = .16; I = 16%), waist circumference-to-height ratio (MD, 0.13 [95% CI, -0.05 to 0.30]; P = .16; I = 94%), dual-energy X-ray absorptiometry (DXA) total fat mass (MD, 0.68 kg [95% CI, -2.39 to 3.79]; P = .66; I = 70%), DXA total fat percent (MD, 0.04% [95% CI, -3.44 to 3.51]; P = .98; I = 56%), DXA total fat-free mass (MD, 0.81 kg [95% CI, -0.96 to 2.58]; P = .37; I = 55%), magnetic resonance imaging visceral adipose tissue volume (MD, 80.97 cm [95% CI, -136.47 to 298.41]; P = .47; I = 78%), and magnetic resonance spectroscopy liver fat percentage (MD, 0.27% [95% CI, -1.26 to 1.79]; P = .73; I = 0%) to those born to mothers who were treated with insulin. Serum adiponectin, leptin, alanine aminotransferase, and ferritin were comparable among groups. In children between the ages of 9 and 11 years, the occurrence of obesity, diabetes, or challenges in motor and social development were comparable between the 2 groups. After 9 years of childbirth, BMI and the risk of developing diabetes were similar between the 2 groups of women.
Metformin use in pregnancy did not show any adverse effects compared with insulin on long-term outcomes in children and their mothers.
关于二甲双胍在治疗妊娠糖尿病/孕期糖尿病方面的应用对分娩后 5 年以上的儿童和母亲的长期结局的影响，相关数据十分有限。本系统评价和荟萃分析旨在评估妊娠期间使用二甲双胍对儿童及其母亲的长期影响。
通过电子数据库检索评估二甲双胍对比胰岛素用于治疗妊娠糖尿病/孕期糖尿病的研究。主要结局为 5 至 11 岁儿童的体重指数（BMI）变化。次要结局为儿童和母亲的其他人体测量指标变化、肥胖、血脂和脂肪细胞因子水平变化。
接受二甲双胍治疗的母亲所生的 9 岁儿童的 BMI（平均差值 [MD]，1.09kg/m [95%置信区间 {CI}，-0.44 至 2.62]；P =.16；I² = 16%）、腰围身高比（MD，0.13 [95% CI，-0.05 至 0.30]；P =.16；I² = 94%）、双能 X 射线吸收法（DXA）总脂肪量（MD，0.68kg [95% CI，-2.39 至 3.79]；P =.66；I² = 70%）、DXA 总脂肪百分比（MD，0.04% [95% CI，-3.44 至 3.51]；P =.98；I² = 56%）、DXA 总去脂体重（MD，0.81kg [95% CI，-0.96 至 2.58]；P =.37；I² = 55%）、磁共振成像内脏脂肪组织体积（MD，80.97cm [95% CI，-136.47 至 298.41]；P =.47；I² = 78%）和磁共振光谱肝脂肪百分比（MD，0.27% [95% CI，-1.26 至 1.79]；P =.73；I² = 0%）与胰岛素治疗组的儿童相似。两组间血清脂联素、瘦素、丙氨酸氨基转移酶和铁蛋白水平无差异。在 9 至 11 岁的儿童中，两组间肥胖、糖尿病或运动和社会发育方面的挑战发生率无差异。分娩 9 年后，两组女性的 BMI 和发生糖尿病的风险相似。
与胰岛素相比，妊娠期间使用二甲双胍对儿童及其母亲的长期结局无不良影响。
