Interventions in women with type 2 diabetes mellitus in the pre-pregnancy, pregnancy and postpartum periods to optimise care and health outcomes: A systematic review

IF 3.2 3区医学 Q2 ENDOCRINOLOGY & METABOLISM Diabetic Medicine Pub Date : 2024-11-11 DOI:10.1111/dme.15474

Sowmiya Gunabalasingam, Artemis Kyrka, Lily Hopkins, Rivka Lebrett, Eleanor Dyer, Rita Forde, Nicola Heslehurst, Claire L. Meek, Danielle A. J. M. Schoenaker, Angela C. Flynn, Sara L. White

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Abstract

Aims

Type 2 diabetes is a chronic condition affecting increasing numbers of women of reproductive age. Recent UK data show more severe adverse offspring outcomes (stillbirth, neonatal death) than in infants of those with Type 1 diabetes. This systematic review aimed to evaluate randomised controlled trials (RCTs) undertaken in the pre-pregnancy, pregnancy and the postpartum periods in women with Type 2 diabetes, to optimise care and health outcomes.

Methods

Six electronic databases were searched for eligible studies from January 2000 to September 2023; eligibility included RCTs of behavioural components, supplementation, pharmacotherapy and/or medical devices. Studies were screened in duplicate, and data were extracted on outcomes including behavioural, anthropometry, clinical measures and maternal and offspring outcomes. A narrative synthesis was performed.

Results

Eleven trials (12 papers) were included (total 1356 women with Type 2 diabetes, n = 25–502). Ten interventions were conducted in pregnancy, and one in the postpartum period. No pre-pregnancy RCTs were identified. Interventions included pharmacotherapies and supplementation, a diabetes-specific antenatal programme, continuous glucose monitoring and postpartum exercise. We found a paucity of interventions limited by inadequate design, statistical power and poor reporting. The largest Type 2 diabetes pregnancy study to date demonstrated evidence of benefit for adding metformin to a standard insulin regimen compared to insulin alone. Other interventions need replication in larger studies among more diverse groups.

Conclusion

This review identified few RCTs targeting women of reproductive age with Type 2 diabetes particularly lacking in the preconception and postpartum periods. Tailored pre-pregnancy, pregnancy and postpartum interventions for women with Type 2 diabetes to optimise care and health outcomes are urgently needed.

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对 2 型糖尿病妇女进行孕前、孕期和产后干预，以优化护理和健康结果：系统综述。

目的：2 型糖尿病是一种慢性病，影响着越来越多的育龄妇女。英国的最新数据显示，与 1 型糖尿病患者的婴儿相比，2 型糖尿病患者的后代会出现更严重的不良后果（死产、新生儿死亡）。本系统综述旨在评估针对 2 型糖尿病女性患者在孕前、孕期和产后进行的随机对照试验（RCT），以优化护理和健康结果：检索了六个电子数据库，以查找 2000 年 1 月至 2023 年 9 月期间符合条件的研究；符合条件的研究包括行为成分、补充剂、药物疗法和/或医疗设备的 RCT。对一式两份的研究进行了筛选，并提取了包括行为、人体测量、临床测量、母婴结果在内的结果数据。结果结果：共纳入 11 项试验（12 篇论文）（共 1356 名 2 型糖尿病妇女，n = 25-502）。其中 10 项干预在孕期进行，1 项在产后进行。未发现孕前 RCT。干预措施包括药物疗法和补充剂、针对糖尿病的产前计划、连续血糖监测和产后锻炼。我们发现，由于设计不足、统计能力不强和报告不完善等原因，干预措施很少。迄今为止规模最大的 2 型糖尿病妊娠研究表明，在标准胰岛素方案中添加二甲双胍比单独使用胰岛素更有益。其他干预措施需要在更多不同群体中进行更大规模的研究：本综述发现，针对育龄女性 2 型糖尿病患者的研究性试验很少，尤其是在孕前和产后时期。我们迫切需要为 2 型糖尿病妇女量身定制孕前、孕期和产后干预措施，以优化护理和健康结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetic Medicine 医学-内分泌学与代谢

CiteScore

7.20

自引率

5.70%

发文量

229

审稿时长

3-6 weeks

期刊介绍： Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”