Open Access妊娠期使用二甲双胍治疗的真实世界经验:来自北部地区妊娠期糖尿病临床登记表的观察性数据
Author(s) -
MapleBrown Louise J.,
Lindenmayer Greta,
Barzi Federica,
Whitbread Cherie,
Connors Christine,
Moore Elizabeth,
Boyle Jacqueline,
Kirkwood Marie,
Lee ILynn,
Longmore Danielle,
van Dokkum Paula,
Wicks Mary,
Dowden Michelle,
Inglis Chrissie,
Cotter Margaret,
Kirkham Renae,
Corpus Sumaria,
Chitturi Sridhar,
Thomas Sujatha,
O'Dea Kerin,
Zimmet Paul,
Oats Jeremy,
McIntyre Harold D.,
Brown Alex,
Shaw Jonathan E.
Publication year - 2019
Publication title -
journal of diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.949
H-Index - 43
eISSN - 1753-0407
pISSN - 1753-0393
DOI - 10.1111/1753-0407.12905
Subject(s) - medicine , gestational diabetes , metformin , pregnancy , obstetrics , odds ratio , type 2 diabetes , diabetes mellitus , confidence interval , body mass index , gestation , endocrinology , genetics , biology
Background In Australia's Northern Territory, Indigenous mothers account for 33% of births and have high rates of hyperglycemia in pregnancy. The prevalence of type 2 diabetes (T2D) in pregnancy is up to 10‐fold higher in Indigenous than non‐Indigenous Australian mothers, and the use of metformin is common. We assessed birth outcomes in relation to metformin use during pregnancy from a clinical register. Methods The study included women with gestational diabetes (GDM), newly diagnosed diabetes in pregnancy (DIP), or pre‐existing T2D from 2012 to 2016. Data were analyzed for metformin use in the third trimester. Regression models were adjusted for maternal age, body mass index, parity, and insulin use. Results Of 1649 pregnancies, 814 (49.4%) were to Indigenous women, of whom 234 (28.7%) had T2D (vs 4.6% non‐Indigenous women; P < 0.001). Metformin use was high in Indigenous women (84%‐90% T2D, 42%‐48% GDM/DIP) and increased over time in non‐Indigenous women (43%‐100% T2D, 14%‐35% GDM/DIP). Among Indigenous women with GDM/DIP, there were no significant differences between groups with and without metformin in cesarean section (51% vs 39%; adjusted odds ratio [aOR] 1.25, 95% confidence interval [CI] 0.87‐1.81), large for gestational age (24% vs 13%; aOR 1.5, 95% CI 0.9‐2.5), or serious neonatal adverse events (9.4% vs 5.9%; aOR 1.32, 95% CI 0.68‐2.57). Metformin use was independently associated with earlier gestational age (37.7 vs 38.5 weeks), but the risk did not remain independently higher after exclusion of women managed with medical nutrition therapy alone, and the increase in births <37 weeks was not significant on multivariate analysis. Conclusions We found no clear evidence of any adverse outcomes related to the use of metformin for the treatment of hyperglycemia in pregnancy.