偏见 SGLT2 或 DPP4 抑制剂的使用和不良妊娠结果
Joel G Ray1, Ziv Harel2, Richard E Gilbert3
1University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, St. Michael's Hospital, Toronto, Ontario, Canada.
Diabetes research and clinical practice
|October 9, 2023
概括
与硫尿素相比,使用-葡萄糖共运输体-2 (SGLT2i) 和二乙酶-4 (DPP4i) 抑制剂并没有增加不良妊娠结果的风险. 这些糖尿病药物对于计划怀孕的女性来说是安全的替代品.
科学领域:
- 生殖内分泌学 生殖内分泌学
- 药理学 药理学是指药理学的学科.
- 孕产妇和胎儿医学 孕产妇和胎儿医学
背景情况:
- 怀孕期间2型糖尿病的管理需要仔细考虑药物安全性.
- -葡萄糖共运输体-2 (SGLT2i) 和二乙酶-4 (DPP4i) 抑制剂越来越多地用于2型糖尿病,但它们的安全预见尚未完全确立.
- 传统上使用过硫基尿素剂,但具有潜在的风险.
研究的目的:
- 为了比较孕前使用SGLT2i和DPP4i与硫氨基酸的安全性和有效性.
- 评估对周围A1c水平的影响.
- 评估怀孕流产和先天异常的风险.
主要方法:
- 基于人口的队列研究在加拿大安大略省 (2007年4月至2021年11月).
- 包括有资格获得免费药物保险的妇女,她们实现了认可的怀孕.
- 暴露时间:SGLT2i,DPP4i,或硫氨酸尿素在怀孕前90天或更长时间内给予. 结果:周周怀孕A1c,怀孕流产,先天异常. 倾向性得分重叠使用的权重.
主要成果:
- 平均经受孕A1c:硫氨酸urea8.1%,DPP4i 8.3%,SGLT2i 7.8%. 这是一个很大的差异.
- 与SGLT2i (RR0.51,95% CI 0.22-0.91) 观察到的怀孕流产风险最低.
- 在将DPP4i或SGLT2i与硫基尿酸相比较时,先天性异常风险没有显著差异.
结论:
- 与硫尿素相比,SGLT2i或DPP4i的孕前使用与A1c发生变化或妊娠不良后果风险增加无关.
- 这些发现表明SGLT2i和DPP4i可能是2型糖尿病妇女计划怀孕的安全替代品.
- 需要进行更大规模的研究来评估怀孕后和胚胎发生期间的药物使用情况.
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