Authors: Hong Ouyang & Na Wu
Abstract
Introduction
A network meta-analysis was conducted to compare and rank the effects of different glucose-lowering measures on maternal and infant outcomes in pregnant women with gestational diabetes mellitus (GDM).
Methods
We searched the PubMed, CNKI, Embase, Cochrane Library, Wanfang, and Weipu databases for relevant studies published between database establishment and June 2021. Study retrieval involved subject-heading and keyword searches. Randomized controlled trials (RCTs) with different glucose-lowering treatments for GDM patients were included. The Cochrane tool was used to assess bias risk. Pairwise and network meta-analyses were used to compare and rank the effects of different hypoglycemic measures on maternal and infant outcomes in pregnant women with GDM.
Results
We included 41 RCTs involving 6245 pregnant women with GDM. Patients treated with insulin had a higher incidence of neonatal intensive care unit (NICU) occupancy (1.3, 95% CI 1.0–1.7) than those treated with metformin. The insulin (1.5, 95% CI 1.1–2.1 and 1.8, 95% CI 1.0–3.3) and glyburide (2.0, 95% CI 1.2–3.2 and 2.5, 95% CI 1.1–8.4) groups exhibited higher incidences of neonatal hypoglycemia and large for gestational age (LGA) newborns than the metformin group. The glyburide group exhibited a lower probability of cesarean section than the metformin (0.76, 95% CI 0.55–1.0) and insulin (0.71, 95% CI 0.52–0.96) groups. Preeclampsia incidence in the diet and exercise groups was significantly lower than in the metformin (0.19, 95% CI 0.043–0.72) and insulin (0.15, 95% CI 0.032–0.52) groups. No intervention significantly reduced the incidences of macrosomia, preterm birth, gestational hypertension, or respiratory distress syndrome (RDS). The ranking results showed that the metformin group had the lowest rates of neonatal hypoglycemia, macrosomia, LGA, and NICU occupancy. The glyburide group had the lowest NICU occupancy and cesarean section rates and the highest neonatal hypoglycemia, LGA, preeclampsia, and gestational hypertension rates. The diet and exercise group had the lowest preterm delivery and preeclampsia rates and the highest NICU occupancy rate.
Conclusion
Metformin is a potentially superior choice for GDM treatment because it is associated with minimal incidences of multiple adverse pregnancy outcome indicators and does not lead to high values of certain adverse outcome indices. Other hypoglycemic agent or diet groups exhibit high incidences of certain adverse outcomes. Therefore, when selecting a GDM treatment strategy, the efficacies and risks of different treatment programs should be evaluated according to the scenario in hand.
Key Summary Points |
Why carry out this study?In recent years, traditional meta-analyses have been used to compare the efficacies and safety of OADs with those of insulin in the treatment of GDM. However, the results have been inconsistent due to a lack of evidence from head-to-head randomized controlled trials (RCTs). Network meta-analysis (NMA) uses direct and indirect data to compare interventions (e.g., in terms of their therapeutic effects) and thus identify the most effective options. Therefore, in order to further evaluate the effects of different treatments, including diet and exercise, OADs, and insulin, on maternal and infant outcomes for pregnant women with GDM, we conducted an NMA of relevant RCTs to elucidate the efficacies and safety of different treatments and thus provide better evidence upon which to base GDM treatment decisions. |
What was learned from this study?Metformin is a potentially superior choice for GDM treatment because it is associated with minimal incidences of multiple adverse pregnancy outcome indicators and does not lead to high values of certain adverse outcome indices. Vitamin D is closely linked to GDM. In the future, GDM treatment should not only involve the selection of appropriate hypoglycemic drugs but should also account for the role of vitamin D in GDM. Assisted reproductive technology (ART) may have an effect on the maternal and infant outcomes of pregnant women with gestational diabetes. |