Palatnik Anna, Feghali Maisa N
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Cardiovascular Center, Medical College of Wisconsin, Milwaukee, Wisconsin.
Am J Perinatol. 2024 Sep 27. doi: 10.1055/a-2407-0905.
The incidence of gestational diabetes mellitus (GDM) continues to increase in the United States and globally. While the first-line treatment of GDM remains diet and exercise, 30% of patients with GDM will require pharmacotherapy. However, many controversies remain over the specific glycemic threshold values at which pharmacotherapy should be started, how intensified the therapy should be, and whether oral agents are effective in GDM and remain safe for long-term offspring health. This review will summarize recently completed and ongoing trials focused on GDM pharmacotherapy, including those examining different glycemic thresholds to initiate therapy and treatment intensity. KEY POINTS: · The incidence of GDM continues to increase in the United States and globally.. · While the first-line treatment of GDM remains diet, 30% of patients require pharmacotherapy.. · Controversies remain over the specific glycemic threshold values at which pharmacotherapy is needed.. · Another controversy is how tightly to control GDM.. · Additional controversies are the safety of metformin and incretins in terms of offspring's long-term health..
在美国和全球范围内，妊娠期糖尿病（GDM）的发病率持续上升。虽然GDM的一线治疗仍然是饮食和运动，但30%的GDM患者将需要药物治疗。然而，关于开始药物治疗的具体血糖阈值、治疗应强化到何种程度以及口服药物在GDM中是否有效且对后代长期健康是否安全等问题，仍存在许多争议。本综述将总结最近完成和正在进行的针对GDM药物治疗的试验，包括那些研究不同血糖阈值以启动治疗和治疗强度的试验。要点：·在美国和全球范围内，GDM的发病率持续上升。·虽然GDM的一线治疗仍然是饮食，但30%的患者需要药物治疗。·关于需要进行药物治疗的具体血糖阈值仍存在争议。·另一个争议是对GDM的控制应有多严格。·其他争议是二甲双胍和肠促胰岛素对后代长期健康的安全性。
