Background: Gestational diabetes mellitus (GDM) is a common metabolic disorder. Hyperglycemia may cause gestational hypertension, increase the probability of infection, abnormal embryonic development, and increase the abortion rate. Oral hypoglycemic drugs may be another effective means of blood glucose control in addition to insulin injection. We included controlled clinical studies for meta-analysis to understand the effect of oral hypoglycemic drugs in gestational diabetes.
Methods: The databases were searched with the keywords "Glycemic control" & "gestational diabetes": Embase (January, 2000-August, 2021), Pubmed (January, 2000-August, 2021), Web of Science (January, 2000-August, 2021), Ovid (January, 2000-August, 2021), and ClinicalTrials.org to obtain the randomized controlled trial (RCT) literatures related to the treatment of gestational diabetes with oral hypoglycemic drugs, after screening, the R language toolkit was used for the analysis.
Results: A total of 10 articles with a total of 1,938 patients were included, 7 studies used metformin as an hypoglycemic agent. Meta-analysis showed that oral metformin had no significant difference in fasting blood glucose levels after the intervention compared with insulin injection [MD = -0.35, 95%CI(-0.70,1.40), Z = 0.66, P = 0.51], with no significant difference in postprandial blood glucose levels after intervention [MD = -2.20, 95%CI(-5.94,1.55), Z = -1.15, P = 0.25], and no statistical difference in glycosylated hemoglobin [MD = 0.10, 95%CI(-0.17,-0.04), Z = -0.94, P = 0.31]. Metformin was more conducive to reducing maternal weight during pregnancy than insulin [MD = -1.55, 95%CI(-2.77,-0.34), Z = -2.5, P = 0.0123], metformin reduced the abortion rate compared with insulin [RR = 0.81, 95%CI(0.63,1.05), Z = -2.61, P = 0.015], and reduced cesarean section rate [RR = 0.66, 95%CI(0.49,0.90), Z = -3.95, P = 0.0001].
Discussion: The application of oral hypoglycemic drug metformin in blood glucose control of gestational diabetes can play a hypoglycemic effect equivalent to insulin and can control the weight of pregnant women, reduce the rate of abortion and cesarean section, and improve pregnancy outcomes.
Keywords: gestational diabetes mellitus; glycemic control; insulin; meta-analysis; oral hypoglycemic agents.
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