口服二甲双胍对肥胖合并妊娠期糖耐量受损孕妇的影响

摘要

Objective To investigate the effect of oral metformin on the maternal labor and offspring′s growth and development in pregnant women with simple obesity complicated with gestational impaired glucose tolerance (GIGT ) .Methods 96 pregnant women with simple obesity complicated with GIGT were selected and divided into three groups ,which were the insulin group with 32 cases treated with insulin ,the metformin group with 34 cases treated with metformin ,and the combined group with 30 cases treated with both insulin and metformin .The data were collected and analyzed retrospectively to compare the changes of the pregnant women′s blood glucose levels before and after treatment ,the maternal and neonatal outcomes ,and the offspring′s growth and development in the 5‐year follow‐ups .Results The fasting and 2‐hour postprandial blood glucose levels in the three groups were significantly lower after treatment than before treatment (P<0.05) ,but there were no significant differences in the blood glucose levels after treatment among the three groups ( P> 0.05 ) . The maternal and neonatal outcomes showed that there were no significant differences in the rate of cesarean section and premature labor and the incidence of pregnancy complications among the three groups (P>0.05) .Meanwhile ,there were no significant differences in the incidence of neonatal malformation ,fetal macrosomia ,jaundice and respiratory distress ,and the rate of being transferred to the department of pediatrics among the three groups (P>0.05) .The follow‐up results showed that the differences in the development of height ,weight and intelligence during the 5 years of follow‐ups were not significant among the three groups (P>0.05) .Conclusion Oral metformin has ideal effect on the regulation of blood glucose levels in pregnant women with simple obesity complicated with GIGT ,while it has no adverse effect on the maternal and neonatal outcomes and the offspring′s grow th and development and the drug safety is high .%目的：探讨肥胖合并妊娠期糖耐量受损（GIGT ）孕妇口服二甲双胍对母体分娩及子代生长发育的影响。方法回顾性分析接受单纯胰岛素治疗（胰岛素组，32例）、单纯二甲双胍治疗（二甲双胍组，34例）或两药物联合治疗（联合组，30例）的96例肥胖合并GIGT孕妇及其新生儿临床资料，观察孕妇治疗前、后血糖水平变化，对比其母婴结局。随访5年其子代生长发育情况。结果治疗后，3组孕妇空腹及餐后2h血糖水平均较治疗前降低，差异有统计学意义（P＜0.05）；3组治疗后的血糖水平比较，差异无统计学意义（P＞0.05）。母婴妊娠结局显示，3组孕妇剖宫产率、早产率及妊娠并发症发生率比较，差异均无统计学意义（P＞0.05），新生儿畸形率、巨大儿率、转儿科率、黄疸率、呼吸窘迫率比较，差异也无统计学意义（ P＞0.05）。随访结果显示，3组受试儿在5年随访期内，身长、体质量及智力发育情况比较，差异均无统计学意义（ P＞0.05）。结论口服二甲双胍对肥胖合并GIGT孕妇血糖水平具有较理想的调控作用，且对其母婴结局及子代生长发育均无不良影响，用药安全性较高。