首页|二甲双胍在妊娠期的应用及思考

二甲双胍在妊娠期的应用及思考

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二甲双胍降低血糖的同时增加胰岛素敏感性,现已成为2型糖尿病一线口服用药.虽然二甲双胍能自由穿过胎盘导致胎儿药物暴露,但是长期的临床使用中并未观察到明显的不良后果,现已应用于妊娠合并肥胖、多囊卵巢综合征、2型糖尿病以及妊娠期糖尿病患者.本文就现有的研究证据进行总结:妊娠期使用二甲双胍可帮助控制血糖及孕期增重,不显著增加母胎近期风险,但通常需要联合使用胰岛素以实现血糖控制,并且二甲双胍妊娠期暴露对后代长期健康的影响存在一定争议,还需更长时间的随访研究以提供更多的临床证据.因此,妊娠期使用二甲双胍需谨慎控制其适应证,不推荐将二甲双胍作为妊娠期血糖控制的一线用药,胰岛素抵抗严重患者可考虑作为辅助用药,对于胰岛素获取困难的资源匮乏地区可考虑限制性使用.
Applications and consideration for metformin in pregnancy
Metformin is recognized for its dual action in lowering blood glucose levels and enhancing insulin sensitivity,positioning it as the primary oral drug for managing type 2 diabetes mellitus(T2DM).Despite its ability to cross the placenta and expose the fetus,extensive clinical application has not revealed significant adverse effects.Metformin finds widespread application during pregnancy in conditions such as obesity,polycystic ovary syndrome,T2DM,and gestational diabetes mellitus.This article aims to establish an evidence-based perspective on the impact of metformin administered during pregnancy on maternal and fetal outcomes,as well as the long-term health of offspring.Generally deemed safe and effective,metformin is viewed as a means to control hyperglycemia and manage gestational weight gain without conspicuous adverse effects on maternal and fetal pregnancy outcomes.However,metformin alone may not suffice for achieving glycemic control,necessitating the addition of insulin.Besides,the long-term offspring risks of metformin exposure are controversial,long-term follow-up study is urgent to bring certainty into this field.Thus,tight control over indications for metformin use during pregnancy is crucial to ensure optimal maternal and fetal health outcomes.Although not suggested as a first-line agent for glycemic control in pregnancy,it may be considered as an adjunctive option in cases of severe insulin resistance or in low-resource areas where access to insulin is challenging.

MetforminPregnancy outcomesLong-term effectRational use

廖玖江、漆洪波

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重庆医科大学附属妇女儿童医院妇产科,重庆 401147

二甲双胍 妊娠结局 远期影响 合理应用

国家自然科学基金面上项目

82171662

2024

中华围产医学杂志
中华医学会

中华围产医学杂志

CSTPCD北大核心
影响因子:1.438
ISSN:1007-9408
年,卷(期):2024.27(1)
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