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Chandrasekar V, Ansari MY, Singh AV, Uddin S, Prabhu KS, Dash S, Khodor SA, Terranegra A, Avella M, Dakua SP. Investigating the Use of Machine Learning Models to Understand the Drugs Permeability Across Placenta. IEEE ACCESS 2023; 11:52726-52739. [DOI: 10.1109/access.2023.3272987] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Affiliation(s)
| | | | | | - Shahab Uddin
- Hamad Medical Corporation, Translational Research Institute, Academic Health System, Doha, Qatar
| | - Kirthi S. Prabhu
- Hamad Medical Corporation, Translational Research Institute, Academic Health System, Doha, Qatar
| | - Sagnika Dash
- Department of Obstetrics and Gynecology, Apollo Clinic, Doha, Qatar
| | - Souhaila Al Khodor
- Maternal and Child Health Department, Research Branch, Sidra Medicine, Ar-Rayyan, Doha, Qatar
| | - Annalisa Terranegra
- Maternal and Child Health Department, Research Branch, Sidra Medicine, Ar-Rayyan, Doha, Qatar
| | - Matteo Avella
- Maternal and Child Health Department, Research Branch, Sidra Medicine, Ar-Rayyan, Doha, Qatar
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Poblete JA, Olmos P. Obesity and Gestational Diabetes in Pregnant Care and Clinical Practice. Curr Vasc Pharmacol 2021; 19:154-164. [PMID: 32598260 DOI: 10.2174/1570161118666200628142353] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/17/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023]
Abstract
Obesity and Gestational Diabetes Mellitus (GDM) are the most frequent pathologies affecting mothers and offspring during pregnancy. Both conditions have shown a sustained increase in their prevalence in recent years, and they worsen the outcome of pregnancy and the long-term health of mothers. Obesity increases the risk of GDM and pre-eclampsia during pregnancy and elevates the risk of developing metabolic syndrome in later life. Offspring of obese mothers have an increased risk of obstetric morbidity and mortality and, consistent with the developmental origins of health and disease, a long term risk of childhood obesity and metabolic dysfunction. On the other hand, GDM also increases the risk of pre-eclampsia, caesarean section, and up to 50% of women will develop type 2 diabetes later in life. From a fetal point of view, it increases the risk of macrosomia, large-for-gestational-age fetuses, shoulder dystocia and birth trauma. The insulin resistance and inflammatory mediators released by a hypoxic trophoblast are mainly responsible for the poor pregnancy outcome in obese or GDM patients. The adequate management of both pathologies includes modifications in the diet and physical activity. Drug therapy should be considered when medical nutrition therapy and moderate physical activity fail to achieve treatment goals. The antenatal prediction of macrosomia is a challenge for physicians. The timing and the route of delivery should consider adequate metabolic control, gestational age, and optimal conditions for a vaginal birth. The best management of these pathologies includes pre-conception planning to reduce the risks during pregnancy and improve the quality of life of these patients.
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Affiliation(s)
- José Andrés Poblete
- Division of Obstetrics and Gynaecology, School of Medicine, Pontificia Universidad Catolica de Santiago, Región Metropolitana, Chile
| | - Pablo Olmos
- Department of Nutrition, School of Medicine, Pontificia Universidad Catolica de Santiago, Región Metropolitana, Chile
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Chaves C, Cunha F, Martinho M, Garrido S, Silva-Vieira M, Estevinho C, Melo A, Figueiredo O, Morgado A, Almeida MC, Almeida M. Metformin combined with insulin in women with gestational diabetes mellitus: a propensity score-matched study. Acta Diabetol 2021; 58:615-621. [PMID: 33459895 DOI: 10.1007/s00592-020-01665-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/24/2020] [Indexed: 01/22/2023]
Abstract
AIM Metformin use in gestational diabetes (GDM) is a common practice. Although its use in combination with insulin might be advantageous, it was never formally tested. We studied whether combined treatment was associated with better obstetric or neonatal outcomes compared to insulin alone. METHODS This is a retrospective study, using the Portuguese National Registry of GDM (2012-2017), of women treated with insulin ± metformin. Primary endpoints were obstetric and neonatal complications. Secondary endpoints were gestational weight gain (GWG) and insulin dose. A propensity score-matched analysis was performed to balance the distribution of age, BMI, insulin treatment duration, HbA1c, first trimester diagnosis of GDM and previous GDM or macrosomia. Women treated with metformin plus insulin and insulin only were then compared. RESULTS A total of 4034 women were treated with insulin or insulin plus metformin (10.2%). After propensity score matching, we studied two groups of 386 patients. Obstetric and neonatal complications were similar. Women treated with metformin plus insulin had 201 (52.1%) obstetric complications versus 184 (47.7%) in insulin-only group, p = 0.22; and 112 (29.0%) neonatal complications versus 96 (24.9%), p = 0.19. Patients treated with metformin plus insulin had similar GWG, excessive weight gain and insulin dose compared to the insulin-only group. CONCLUSIONS Women with GDM treated with insulin plus metformin had similar obstetric and neonatal complications, weight gained and insulin dose compared to those only treated with insulin.
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Affiliation(s)
- Catarina Chaves
- Serviço de Endocrinologia do Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007, Guilhufe, Penafiel, Portugal.
| | - Filipe Cunha
- Serviço de Endocrinologia do Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007, Guilhufe, Penafiel, Portugal
| | - Mariana Martinho
- Serviço de Endocrinologia do Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007, Guilhufe, Penafiel, Portugal
| | - Susana Garrido
- Serviço de Endocrinologia do Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007, Guilhufe, Penafiel, Portugal
| | - Margarida Silva-Vieira
- Serviço de Endocrinologia do Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007, Guilhufe, Penafiel, Portugal
| | - Catarina Estevinho
- Serviço de Ginecologia e Obstetrícia do Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Anabela Melo
- Serviço de Ginecologia e Obstetrícia do Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Odete Figueiredo
- Serviço de Ginecologia e Obstetrícia do Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Ana Morgado
- Serviço de Ginecologia e Obstetrícia do Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Maria Céu Almeida
- Serviço de Obstetrícia, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Margarida Almeida
- Serviço de Endocrinologia do Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007, Guilhufe, Penafiel, Portugal
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Guo L, Ma J, Tang J, Hu D, Zhang W, Zhao X. Comparative Efficacy and Safety of Metformin, Glyburide, and Insulin in Treating Gestational Diabetes Mellitus: A Meta-Analysis. J Diabetes Res 2019; 2019:9804708. [PMID: 31781670 PMCID: PMC6875019 DOI: 10.1155/2019/9804708] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/03/2019] [Accepted: 08/11/2019] [Indexed: 11/18/2022] Open
Abstract
To compare the efficacy and safety of metformin, glyburide, and insulin in treating gestational diabetes mellitus (GDM), a meta-analysis of randomized controlled trials (RCTs) was conducted. PubMed, Embase, CINAHL, Web of Science, and Cochrane Library to November 13, 2018, were searched for RCT adjusted estimates of the efficacy and safety of metformin, glyburide, and insulin treatments in GDM patients. There were 41 studies involving 7703 GDM patients which were included in this meta-analysis; 12 primary outcomes and 24 secondary outcomes were detected and analyzed. Compared with metformin, insulin had a significant increase in the risk of preeclampsia (RR, 0.57; 95% CI, 0.45 to 0.72; P < 0.001), NICU admission (RR, 0.75; 95% CI, 0.64 to 0.87; P < 0.001), neonatal hypoglycemia (RR, 0.57; 95% CI, 0.49 to 0.66; P < 0.001), and macrosomia (RR, 0.68; 95% CI, 0.55 to 0.86; P < 0.05). To the outcomes of birth weight and gestational age at delivery, insulin had a significant increase when compared with metformin (MD, 114.48; 95% CI, 37.32 to 191.64; P < 0.01; MD, 0.23; 95% CI, 0.12 to 0.34; P < 0.001; respectively). Of the two groups between glyburide and metformin, metformin had lower gestational weight gain compared with glyburide (MD, 1.67; 95% CI, 0.26 to 3.07; P < 0.05). Glyburide had a higher risk of neonatal hypoglycemia compared with insulin (RR, 1.76; 95% CI, 1.32 to 2.36; P < 0.001). This meta-analysis found that metformin could be a safe and effective treatment for GDM. However, clinicians should pay attention on the long-term offspring outcomes of the relative data with GDM patients treated with metformin. Compared with insulin, glyburide had a higher increase of neonatal hypoglycemia. The use of glyburide in pregnancy for GDM women appears to be unclear.
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Affiliation(s)
- Lanlan Guo
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Jing Ma
- Department of Endocrinology and Metabolism, Gansu Provincial Hospital, Lanzhou 730000, China
| | - Jia Tang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200041, China
| | - Dingyao Hu
- The Second Clinical Medical College, Lanzhou University, Lanzhou 730000, China
| | - Wei Zhang
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical College, Zunyi 563000, China
| | - Xue Zhao
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
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Metformin versus insulin for gestational diabetes: The reporting of ethnicity and a meta-analysis combining English and Chinese literatures. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.obmed.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Regensteiner JG, Golden S, Huebschmann AG, Barrett-Connor E, Chang AY, Chyun D, Fox CS, Kim C, Mehta N, Reckelhoff JF, Reusch JEB, Rexrode KM, Sumner AE, Welty FK, Wenger NK, Anton B. Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus: A Scientific Statement From the American Heart Association. Circulation 2015; 132:2424-47. [PMID: 26644329 DOI: 10.1161/cir.0000000000000343] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Kalra B, Gupta Y, Singla R, Kalra S. Use of oral anti-diabetic agents in pregnancy: a pragmatic approach. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015; 7:6-12. [PMID: 25709972 PMCID: PMC4325398 DOI: 10.4103/1947-2714.150081] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Insulin is the gold standard for treatment of hyperglycemia during pregnancy, when lifestyle measures do not maintain glycemic control during pregnancy. However, recent studies have suggested that certain oral hypoglycemic agents (metformin and glyburide) may be safe and be acceptable alternatives. There are no serious safety concerns with metformin, despite it crossing the placenta. Neonatal outcomes are also comparable, with benefit of reductions in neonatal hypoglycemia, maternal hypoglycemia and weight gain, and improved treatment satisfaction. Glibenclamide is more effective in lowering blood glucose in women with gestational diabetes, and with a lower treatment failure rate than metformin. Although generally well-tolerated, some studies have reported higher rates of pre-eclampsia, neonatal jaundice, longer stay in the neonatal care unit, macrosomia, and neonatal hypoglycaemia. There is also paucity of long-term follow-up data on children exposed to oral agents in utero. This review aims to provide an evidence-based approach, concordant with basic and clinical pharmacological knowledge, which will help medical practitioners use oral anti-diabetic agents in a rational and pragmatic manner. Pubmed search was made using Medical Subject Headings (MESH) terms “Diabetes” and “Pregnancy” and “Glyburide”; “Diabetes” and “Pregnancy” and “Metformin”. Limits were randomized controlled trials (RCTs) and meta-analysis. The expert reviews on the topic were also used for discussion. Additional information (studies/review) pertaining to discussion under sub-headings like safety during breastfeeding; placental transport; long-term safety data were searched (pubmed/cross-references/expert reviews).
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Affiliation(s)
- Bharti Kalra
- Consultant, Department of Obstetrics and Gynaecology, Bharti Hospital, Karnal, Haryana, India
| | - Yashdeep Gupta
- Department of Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Rajiv Singla
- Consultant, Department of Endocrinology and Metabolism, Saket City Hospital, New Delhi, India
| | - Sanjay Kalra
- Consultant, Department of Endocrinology and Metabolism, Bharti Hospital, Karnal, Haryana, India
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Abstract
In gestational diabetes (GDM), achieving euglycemia through treatment decreases the risk of adverse outcomes associated with hyperglycemia. Treatment starts with diet and nutritional counseling; however, up to 50% of women will require pharmacologic therapy to meet glucose goals. Although insulin remains the only Federal Drug Administration-approved agent to treat GDM, oral hypoglycemic agents are an attractive and increasingly common alternative. Research suggests that glyburide and metformin can each effectively manage hyperglycemia in pregnancy. This review highlights research on efficacy, safety, and advantages versus disadvantages of each. We offer management and counseling strategies for clinicians caring for patients with GDM.
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Feldman DM, Fang YMV. Use of oral hypoglycemic and insulin agents in pregnant patients. Clin Lab Med 2013; 33:235-42. [PMID: 23702114 DOI: 10.1016/j.cll.2013.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although insulin remains the standard medication for the treatment of all types of patients with diabetes during pregnancy, oral hypoglycemics may be considered as alternative medications in the treatment of some types of diabetes in pregnancy.
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Affiliation(s)
- Deborah M Feldman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT 06102, USA
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Sirmans SM, Weidman-Evans E, Everton V, Thompson D. Polycystic Ovary Syndrome and Chronic Inflammation: Pharmacotherapeutic Implications. Ann Pharmacother 2012; 46:403-18. [DOI: 10.1345/aph.1q514] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective: To examine the relationship between polycystic ovary syndrome (PCOS), cardiovascular risk factors, cardiovascular disease (CVD), and chronic inflammation and analyze data regarding pharmacologic therapies that are recommended to reduce CVD risk in PCOS and the impact of those therapies on chronic inflammation. Data Sources: A search of MEDLINE (1950-October 2011) was conducted to identify clinical studies pertaining to the identification and treatment of CVD and chronic low-grade inflammation in PCOS, Search terms included polycystic ovary syndrome, cardiovascular disease, inflammation, metformin, thiazolidinedione, and statin. Bibliographies of these studies and review articles were also examined. Study Selection and Data Extraction: English-language clinical studies evaluating the effect of metformin, thiazolidinediones, and statins on inflammatory markers, endothelial function, adhesion molecules, fibrinolysis, cytokines, and adipokines in PCOS were included. Data Synthesis: Women with PCOS have an increased prevalence of many cardiovascular risk factors including obesity, android fat distribution, insulin resistance, impaired glucose tolerance, diabetes, dyslipidemia, hypertension, and metabolic syndrome. Markers of chronic low-grade inflammation, which are associated with an increased risk of CVD, are also elevated in PCOS. Clinical guidelines recommend the use of insulin sensitizers and statins to prevent CVD in some patients with PCOS. Current literature indicates that each of these medication classes has beneficial effects on inflammation, as well. Although there are currently no studies to determine whether these treatments decrease CVD in PCOS, it can be hypothesized that drugs impacting chronic inflammation may reduce cardiovascular risk. Some studies show that metformin, thiazolidinediones, and statins have beneficial effects on inflammatory markers in PCOS; however, the data are inconsistent. Conclusions: There is insufficient information to recommend any pharmacologic therapies for their antiinflammatory effects in PCOS in the absence of other indications such as diabetes and dyslipidemia.
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Affiliation(s)
- Susan Maureen Sirmans
- Department of Clinical and Administrative Sciences, College of Pharmacy, University of Louisiana at Monroe
| | - Emily Weidman-Evans
- Department of Clinical and Administrative Sciences, College of Pharmacy, University of Louisiana at Monroe; Clinical Assistant Professor (gratis), Department of Family Medicine and Comprehensive Care, Louisiana State University Health Sciences Center-Shreveport
| | - Victoria Everton
- Department of Family Medicine and Comprehensive Care, Louisiana State University Health Sciences Center-Shreveport
| | - Daniel Thompson
- Department of Family Medicine and Comprehensive Care, Louisiana State University Health Sciences Center-Shreveport
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