Physical exercise and metformin in gestational obesity and prevention on gestational diabetes mellitus: a systematic review

Abstract Objectives: identify the action of metformin and physical activities to reduce weight gain and prevent mellitus diabetes in obese pregnant women. Methods: the electronic search was performed in PubMed / MEDLINE, LILACS, Web of Science, Scopus and Cochrane library databases between 2008 and 2018. The selection took place between April and July 2018, through the descriptors "pregnancy, obesity, metformin, treatment, exercise". A protocol was programmed and consecutively a selective research on the inclusion / exclusion phase. The "PICO" strategy was used. Population: obese pregnant women. Intervention: physical exercises and metformin. Control: The main indicator established was therapeutic outcomes with physical activity and metformin. Outcome of interest: body weight control. Results: by selecting the database, 3,983 articles were identified on the topic of interest. After selecting and eligibility, only 16 scientific studies were selected, of which 81.25% were clinical trials related to diet programs, physical activity, metformin use and possible outcomes, 18.75% were prospective cohort on causes of obesity in gestation and its association with gestational mellitus diabetes and preventive therapies. The study pointed out the possibility of adapting physical therapy programs with the correct metformin dosage for a greater control in gestational weight gain. However, there is a need for greater awareness and changes in habits for obese woman during the gestational period. Conclusions: the drug presents similarity to physical activity by activating AMPK and may be added to treatments that propose changes in pregnant women’s lifestyle to reduce weight gain and prevent gestational diabetes mellitus with a better understanding of the optimal dosage. Thus, the study suggests the use of metformin is not only for the prevention and the intercurrence of gestational diabetes mellitus, but a strictly careful investigation allowing its use to non-diabetic obese pregnant women.

摘要 研究目的：明确二甲双胍（metformin）与体育运动在肥胖孕妇群体中减轻妊娠期体重增长、预防妊娠糖尿病的作用。研究方法：于2008年至2018年间，在PubMed/MEDLINE、LILACS、Web of Science、Scopus及Cochrane图书馆数据库中开展电子检索。文献筛选工作于2018年4月至7月进行，以“妊娠、肥胖、二甲双胍、治疗、运动”作为主题检索词，预先制定研究方案并依次开展纳入/排除阶段的选择性文献筛选，采用PICO策略。研究对象：肥胖孕妇。干预措施：体育锻炼与二甲双胍。对照设置：主要确立的评价指标为体育活动联合二甲双胍的治疗结局。关注结局：体重控制情况。研究结果：经数据库检索共识别出3983篇与研究主题相关的文献。经过筛选与资格审核后，最终纳入16项科学研究，其中81.25%为涉及饮食方案、体育活动、二甲双胍使用及相关结局的临床试验，18.75%为探讨妊娠期肥胖病因、其与妊娠糖尿病关联及预防疗法的前瞻性队列研究。本研究提示，可通过优化体育锻炼方案并配合适宜的二甲双胍剂量，更有效地控制妊娠期体重增长，但仍需提升肥胖孕妇在妊娠期的健康认知并改善其生活习惯。研究结论：二甲双胍可通过激活腺苷酸活化蛋白激酶（AMPK）发挥与体育运动相似的生理作用，可在明确最佳给药剂量的前提下，纳入旨在改善孕妇生活方式的治疗方案，以减轻体重增长、预防妊娠糖尿病。本研究提示，二甲双胍不仅可用于妊娠糖尿病的预防与发病干预，还需开展严谨的探索性研究，以支持其在非糖尿病肥胖孕妇中的应用。