口服降糖药在妊娠期糖尿病的应用进展

An objective assessment of research on oral hypoglycemic agents and gestational diabetes mellitus

妊娠期糖尿病(GDM)是产科常见的合并症,妊娠期高血糖对母、婴的影响程度取决于孕期母亲血糖的控制水平,合理控制孕期高血糖对母、婴的近远期均十分重要。大多数GDM患者可以通过控制饮食即可达到满意控制血糖的目的 ,其余患者需加用药物治疗。传统观点视胰岛素为治疗GDM的唯一选择,因为口服降糖药可透过胎盘致胎儿低血糖、畸形等,且远期影响尚不明确,所以其临床应用受到限制。近年来,国内外学者致力于口服降糖药的研究,妊娠期口服降糖药的动物实验和临床研究显示:二甲双胍、格列本脲及阿卡波糖未发现致畸作用,但评价其治疗价值仍需大量临床资料的积累。

As gestational diabetes is associated with adverse pregnancy outcomes,and has long-term implications for both mother and child,it is important that it is recognized and appropriately managed.Choices of treatment drugs in pregnant patients should take into account of the effects on the fetus.There is a controversy regarding the use of oral hypoglycemic agents during pregnancy.Insulin has been the unique choice treatment in most parts of the world for GDM.Evidence is inadequate to support the use of oral hypoglycemic agents,an agent that has been shown to cross the placenta and thus could be harmful to the developing fetus including neonatal hypoglycemia and malformations.There have now however,been animal experiments and randomized trials conducted with metformin,glyburide and acarbose,which have not demonstrated harm to the pregnancy in malformations.Although most of randomized trials have demonstrated noninferiority of glyburide and metformin in achieving glycemic control,and satisfactory birth outcomes compared to insulin therapy,concerns must remain as long-term issues have not yet been addressed.Further sufficiently powered and randomized clinical studies are still needed in order to determine the role of oral hypoglycemic agents as an alternative treatment to insulin in GDM patients.