A meta-analysis of metformin and insulin on maternal outcome and neonatal outcome in patients with gestational diabetes mellitus.

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY Journal of Maternal-Fetal & Neonatal Medicine Pub Date : 2024-12-01 Epub Date: 2023-12-20 DOI:10.1080/14767058.2023.2295809

Rui Wu, Qingqing Zhang, Zuojing Li

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Abstract

Introduction: 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.

Methods: 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.

Results: 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, p < .0001), induction of labor (RR 0.90, 95% CI 0.82 to 0.98, p = .02), cesarean delivery (RR 0.91, 95% CI 0.85 to 0.98, p = .01), macrosomia (RR 0.67, 95% CI 0.53 to 0.83, p = .0004), neonatal intensive care unit (NICU) admission (RR 0.75, 95% CI 0.66 to 0.86, p < .0001), neonatal hypoglycemia (RR 0.55, 95% CI 0.48 to 0.63, p < .00001), and large for gestational age (LGA) (RR 0.80, 95% CI 0.68 to 0.94, p = .007). Conversely, metformin showed no significant impact on gestational hypertension (RR 0.84, 95% CI 0.67 to 1.06, p = .15), spontaneous vaginal delivery (RR 1.13, 95% CI 1.00 to 1.08, p = .05), emergency cesarean section (RR 0.94, 95% CI 0.77 to 1.16, p = .58), shoulder dystocia (RR 0.65, 95% CI 0.31 to 1.39, p = .27), premature birth (RR 0. 92, 95% CI 0.61 to 1.39, p = .69), polyhydramnios (RR 1.11, 95% CI 0.54 to 2.30, p = .77), birth trauma (RR 0.87, 95% CI 0.54 to 1.39, p = .56), 5-min Apgar score < 7 (RR 1.13, 95% CI 0.76 to 1.68, p = .55), small for gestational age (SGA) (RR 0.93, 95% CI 0.71 to 1.22, p = .62), respiratory distress syndrome (RDS) (RR 0.74, 95% CI 0.50 to 1.08, p = .11), jaundice (RR 1.09, 95% CI 0.95 to 1.25, p = .24) or birth defects (RR 0.80, 95% CI 0.37 to 1.74, p = .57).

Conclusions: 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.

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二甲双胍和胰岛素对妊娠糖尿病患者的母体预后和新生儿预后的荟萃分析。

导言：由于二甲双胍可通过胎盘，因此使用二甲双胍治疗妊娠糖尿病（GDM）仍存在争议。这项荟萃分析旨在比较二甲双胍和胰岛素对 GDM 患者的孕产妇和新生儿预后的影响：我们对 PubMed、Embase 和 Cochrane 图书馆数据库进行了全面检索，重点检索了评估二甲双胍和胰岛素对 GDM 患者产妇和新生儿预后影响的随机对照试验 (RCT)：本次荟萃分析共纳入了 24 项随机对照试验，涉及 4934 名 GDM 患者。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，P = .02）、剖宫产（RR 0.91，95% CI 0.85至0.98，P = .01）、巨大儿（RR 0.67，95% CI 0.53至0.83，P = .0004）、入住新生儿重症监护室（NICU）（RR 0.75，95% CI 0.66至0.86，P = .007）。相反，二甲双胍对妊娠高血压（RR 0.84，95% CI 0.67 至 1.06，P = .15）、自然阴道分娩（RR 1.13，95% CI 1.00 至 1.08，P = .05）、紧急剖宫产（RR 0.94，95% CI 0.77 至 1.16，p = .58）、肩难产（RR 0.65，95% CI 0.31 至 1.39，p = .27）、早产（RR 0.92，95% CI 0.61 至 1.39，p = .69）、多胎妊娠（RR 1.11，95% CI 0.54 至 2.30，p = .77）、产伤（RR 0.87，95% CI 0.54 至 1.39，p = .56）、5 分钟 Apgar 评分 < 7（RR 1.13，95% CI 0.76 至 1.68，p = .55）、胎龄小（SGA）（RR 0.93，95% CI 0.71 至 1.22，p = .62）、呼吸窘迫综合征（RDS）（RR 0.74，95% CI 0.50 至 1.08，P = .11）、黄疸（RR 1.09，95% CI 0.95 至 1.25，P = .24）或出生缺陷（RR 0.80，95% CI 0.37 至 1.74，P = .57）：研究结果表明，与胰岛素治疗 GDM 相比，二甲双胍可降低某些孕产妇和新生儿结局的风险。然而，还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。

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来源期刊

Journal of Maternal-Fetal & Neonatal Medicine 医学-妇产科学

CiteScore

4.40

自引率

0.00%

发文量

217

审稿时长

2-3 weeks

期刊介绍： The official journal of The European Association of Perinatal Medicine, The Federation of Asia and Oceania Perinatal Societies and The International Society of Perinatal Obstetricians. The journal publishes a wide range of peer-reviewed research on the obstetric, medical, genetic, mental health and surgical complications of pregnancy and their effects on the mother, fetus and neonate. Research on audit, evaluation and clinical care in maternal-fetal and perinatal medicine is also featured.