Is metformin safe in pregnancy: a focus on offspring outcomes.

IF 3 3区 医学 Q2 PHARMACOLOGY & PHARMACY Expert Opinion on Drug Safety Pub Date : 2024-11-04 DOI:10.1080/14740338.2024.2424410
Rana Malek, Stephen N Davis
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Abstract

Introduction: Metformin has been part of treatment algorithms for type 2 diabetes mellitus (T2DM) for decades. While it has formal approval in the U.S.A. for treatment of T2DM, it is used off-label in gestational diabetes mellitus (GDM), polycystic ovarian syndrome (PCOS), and ovarian hyperstimulation prevention. Its role as an insulin sensitizer has made it an attractive therapeutic to address the insulin resistance seen in these syndromes. In 2022, the European Union approved metformin as the only oral antidiabetic medication for diabetes in pregnancy. While its safety and benefits for the mother are well documented, it does cross the placenta with plasma concentrations comparable between mother and child at delivery.

Areas covered: This special report will focus on major randomized control trials investigating metformin use in pregnancies impacted by PCOS, GDM, T2DM, and obesity and their offspring follow-up trials.

Expert opinion: For the mother, metformin can be beneficial, with reduction in insulin therapeutic burden, weight gain, hypoglycemia and in certain situations, pre-eclampsia. For the neonate, benefits may include reduction in hypoglycemia and no increased risk of congenital anomalies. It is the long-term data in the offspring that remains unknown with some areas of concerns (SGA, altered anthropometrics) requiring continued research.

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二甲双胍在孕期是否安全:关注后代的结果。
简介数十年来,二甲双胍一直是 2 型糖尿病(T2DM)治疗方案的一部分。虽然二甲双胍在美国已被正式批准用于治疗 T2DM,但它也被用于妊娠糖尿病(GDM)、多囊卵巢综合征(PCOS)和卵巢过度刺激预防。胰岛素增敏剂的作用使其成为解决这些综合征中出现的胰岛素抵抗的一种有吸引力的疗法。2022 年,欧盟批准二甲双胍作为治疗妊娠糖尿病的唯一口服抗糖尿病药物。虽然二甲双胍的安全性和对母亲的益处有据可查,但它会穿过胎盘,母亲和婴儿在分娩时的血浆浓度相当:本特别报告将重点关注调查二甲双胍在受多囊卵巢综合征、糖尿病、T2DM 和肥胖症影响的妊娠中使用情况的主要随机对照试验及其后代随访试验:专家观点:二甲双胍对母亲有益,可减少胰岛素治疗负担、体重增加、低血糖,在某些情况下还可减少先兆子痫。对新生儿而言,二甲双胍的益处可能包括减少低血糖,以及不会增加先天性畸形的风险。后代的长期数据仍是未知数,一些令人担忧的方面(SGA、人体测量学改变)需要继续研究。
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来源期刊
CiteScore
5.90
自引率
3.20%
发文量
97
审稿时长
6-12 weeks
期刊介绍: Expert Opinion on Drug Safety ranks #62 of 216 in the Pharmacology & Pharmacy category in the 2008 ISI Journal Citation Reports. Expert Opinion on Drug Safety (ISSN 1474-0338 [print], 1744-764X [electronic]) is a MEDLINE-indexed, peer-reviewed, international journal publishing review articles on all aspects of drug safety and original papers on the clinical implications of drug treatment safety issues, providing expert opinion on the scope for future development.
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