دورية أكاديمية
Neonatal outcome following metformin-treated gestational diabetes mellitus: A population-based cohort study.
| العنوان: | Neonatal outcome following metformin-treated gestational diabetes mellitus: A population-based cohort study. |
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| المؤلفون: | Molin J; Department of Clinical Sciences, Umeå University, Umeå, Sweden., Domellöf M; Department of Clinical Sciences, Umeå University, Umeå, Sweden., Häggström C; Northern Registry Center, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden., Vanky E; Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.; Department of Obstetrics and Gynecology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway., Zamir I; Department of Clinical Sciences, Umeå University, Umeå, Sweden., Östlund E; Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden., Bixo M; Department of Clinical Sciences, Umeå University, Umeå, Sweden. |
| المصدر: | Acta obstetricia et gynecologica Scandinavica [Acta Obstet Gynecol Scand] 2024 May; Vol. 103 (5), pp. 992-1007. Date of Electronic Publication: 2024 Jan 30. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Wiley Country of Publication: United States NLM ID: 0370343 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1600-0412 (Electronic) Linking ISSN: 00016349 NLM ISO Abbreviation: Acta Obstet Gynecol Scand Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2011- : Malden, MA : Wiley Original Publication: Copenhagen : Munksgaard |
| مواضيع طبية MeSH: | Metformin*/adverse effects , Diabetes, Gestational*/epidemiology , Diabetes, Gestational*/drug therapy , Premature Birth*/epidemiology , Hypoglycemia*/chemically induced , Hypoglycemia*/epidemiology , Infant, Newborn, Diseases*, Pregnancy ; Infant, Newborn ; Female ; Humans ; Child, Preschool ; Hypoglycemic Agents/adverse effects ; Cohort Studies ; Insulin/therapeutic use ; Pregnancy Outcome |
| مستخلص: | Introduction: Neonatal hypoglycemia is a common complication associated with gestational diabetes and therefore relevant to consider in evaluations of maternal treatment. We aimed to investigate the risk of neonatal hypoglycemia in offspring exposed to metformin treatment alone (MT) or combined with insulin (MIT) in comparison with nutrition therapy alone (NT), and insulin treatment alone (IT). In addition, we investigated MT in comparison with MIT. Secondary outcomes included neonatal anthropometrics, respiratory morbidity, hyperbilirubinemia, 5-min Apgar score, and preterm birth. Material and Methods: This Swedish population-based cohort included 16 181 women diagnosed with gestational diabetes, and their singleton offspring born in 2019-2021. We estimated risk as adjusted odds ratio (aOR) with 95% confidence interval (CI), using individual-level, linkage register-data in multivariable logistic regression models. Results: In the main analysis, MT was associated with a lower risk of neonatal hypoglycemia vs NT (aOR 0.85, 95% CI: 0.74-0.96), vs MIT (0.74 [0.64-0.87]), and vs IT (0.47 [0.40-0.55]), whereas MIT was associated with a similar risk of neonatal hypoglycemia vs NT (1.14 [0.99-1.30]) and with lower risk vs IT (0.63 [0.53-0.75]). However, supplemental feeding rates were lower for NT vs pharmacological treatments (p < 0.001). In post hoc subgroup analyses including only exclusively breastfed offspring, the risk of neonatal hypoglycemia was modified and similar among MT and NT, and higher in MIT vs NT. Insulin exposure, alone or combined with metformin, was associated with increased risk of being large for gestational age. Compared with NT, exposure to any pharmacological treatment was associated with significantly lower risk of 5-min Apgar score < 4. All other secondary outcomes were comparable among the treatment categories. Conclusions: The risk of neonatal hypoglycemia appears to be comparable among offspring exposed to single metformin treatment and nutrition therapy alone, and the lower risk that we observed in favor of metformin is probably explained by a difference in supplemental feeding practices rather than metformin per se. By contrast, the lower risk favoring metformin exposure over insulin exposure was not explained by supplemental feeding. However, further investigations are required to determine whether the difference is an effect of metformin per se or mediated by other external factors. (© 2024 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).) |
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| معلومات مُعتمدة: | C-ALF 7004352 Västerbotten county council; 310426017-Holmstens Foundation Umeå University |
| فهرسة مساهمة: | Keywords: gestational diabetes mellitus; metformin; neonatal hypoglycemia; neonatal outcome; population‐based; register‐based |
| المشرفين على المادة: | 9100L32L2N (Metformin) 0 (Hypoglycemic Agents) 0 (Insulin) |
| تواريخ الأحداث: | Date Created: 20240130 Date Completed: 20240417 Latest Revision: 20240425 |
| رمز التحديث: | 20240425 |
| مُعرف محوري في PubMed: | PMC11019529 |
| DOI: | 10.1111/aogs.14787 |
| PMID: | 38288656 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1600-0412 |
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| DOI: | 10.1111/aogs.14787 |