Gestational diabetes: treatment with metformin compared to insulin

妊娠期糖尿病（GDM）是指妇女在怀孕期间检测到血糖水平升高。治疗的目的是保持母亲的血糖正常，并防止多余的糖传递给婴儿，因为这会导致婴儿体内胰岛素水平升高，以及随后的并发症。最初的治疗是通过饮食，但30%以上的妇女需要进一步注射胰岛素治疗。二甲双胍可以作为片剂服用，是胰岛素的替代品，广泛用于妊娠期以外的糖尿病患者。有很好的数据支持妊娠期使用二甲双胍的安全性。我们计划测试二甲双胍不仅是安全的，而且对于患有GDM的女性来说是胰岛素的有效替代品。二甲双胍通过降低对胰岛素的抵抗而起作用，这是GDM和高血压并发症发展的关键因素。我们希望证明二甲双胍治疗可以减少这些并发症。与胰岛素相比，二甲双胍与体重增加较少相关，我们希望证明二甲双胍治疗的GDM妇女妊娠后糖尿病风险的相关降低。二甲双胍很可能穿过胎盘，如果是这样，它可能会降低婴儿体内升高的胰岛素水平。这项研究将测量脐带血中的胰岛素水平，希望证明更多的婴儿在接受二甲双胍治疗后胰岛素水平正常。

Gestational diabetes (GDM) is diagnosed when women have elevated blood sugar levels detected in pregnancy. Treatment aims to keep the mother's blood sugar normal and to prevent extra sugar transferring to the baby, as this can lead to elevated insulin levels, and subsequent complications, in the baby. Initial treatment is by diet, but more than 30% of women need further treatment with insulin injections. Metformin, which can be taken by as a tablet, is an alternative to insulin that is used widely outside pregnancy for people with diabetes. There are good data to support the safety of metformin in pregnancy. We plan to test that metformin is not only safe but also an effective alternative to insulin for women with GDM. Metformin works by reducing resistance to insulin, which is a key factor for the development of GDM and also for high blood pressure complications. We hope to demonstrate a reduction in these complications with metformin treatment. Metformin is associated with less weight gain than insulin and we hope to demonstrate an associated reduction in the risk of diabetes following pregnancy in women with GDM treated with metformin. It is likely that metformin crosses the placenta, and if so, it may reduce elevated insulin levels in the baby. The study will measure insulin levels in the cord blood, hoping to demonstrate that more babies have normal insulin levels in pregnancies treated with metformin.