二甲双胍联合标准胰岛素治疗对2型糖尿病孕妇妊娠结局及新生儿结局的影响

Effects of metformin combined with routine insulin therapy on neonatal and maternal outcomes in pregnant women with type 2 diabetes

目的探讨在胰岛素治疗方案中加入二甲双胍对妊娠期2型糖尿病孕妇妊娠结局及新生儿结局的影响。方法以2019年1月至2020年1月我院产科收治的妊娠期糖尿病患者为研究对象,共43例,随机分为对照组和治疗组。对照组给予常规胰岛素治疗,治疗组给予胰岛素联合二甲双胍治疗。比较两组新生儿结局、产妇妊娠结局及产妇不良反应发生率。结果在主要新生儿结局如妊娠丢失、早产、新生儿产伤、呼吸窘迫综合征、新生儿低血糖症和NICU入住率方面,两组差异无统计学意义(P>0.05)。与对照组相比,治疗组孕妇所生的新生儿出生体重较低,新生儿超重比例小,肥胖程度也较低,差异具有统计学意义(P<0.05)。治疗组孕妇血糖控制得更好,对胰岛素的需求更低,且妊娠期体重增加率、剖腹产手术率均显著降低(P<0.05)。两组的不良反应主要有恶心呕吐、胃肠道不适、头痛、感染、呼吸系统疾病和尿路感染,不良反应发生率差异无统计学意义(P>0.05)。结论二甲双胍联合常规胰岛素治疗可显著改善孕妇血糖控制,降低胰岛素需求,减少体重增加、减少剖腹产率,同时显著降低新生儿肥胖,包括大于胎龄儿比例、新生儿超重比例降低,小于胎龄儿比例增加。

Objective To investigate the efficacy of metformin combined with routine insulin therapy on neonatal and maternal outcomes in pregnant women with type 2 diabetes.Methods A total of 43 pregnant women with type 2 diabetes from January 2019 to January 2020 were included in this study.Patients were randomly divided into control group and combination treatment group.Patients in the control group were treated with insulin alone and patients in the combination treatment group received metformin combined with insulin.The neonatal and maternal outcomes and adverse events were recorded and compared between the two groups.Results There was no statistical differences between the two groups in the main neonatal pregnancy outcomes,including pregnancy loss,preterm birth,birth injury,respiratory distress syndrome,neonatal hypoglycemia and NICU admission rate(P>0.05).However,there were fewer newborns large for gestational age but a higher proportion of small-for-gestational-age newborns in the metformin combination group when compared with control group(P<0.05).Besides,we observed better maternal glycemic control in the combination treatment group,along with reduced maternal weight gain,insulin dosage,and rate of caesarean section.The main adverse events of the two groups included nausea and vomiting,gastrointestinal discomfort,headache,infection,respiratory diseases and urinary tract infection,and there was no statistical difference in the incidence of adverse events between the two groups.Conclusion Metformin combined with insulin therapy can significantly improve maternal glycemic control,reduce the demand for insulin,weight gain,and rate of cesarean section;meanwhile,it significantly decreases neonatal obesity including the proportion of large-for-gestational-age neonates.The proportion of neonatal overweight is reduced,and the proportion of small-for-gestational-age neonates is increased.