Evaluation of Preeclampsia Results after Use of Metformin in Gestation: Systematic Review and Meta-analysis

Abstract Objective Does the use of metformin have an influence on the outcomes of preeclampsia (PE)? Sources of Data The descriptors pregnancy, metformin, treatment, and preeclampsia associated with the Boolean operators AND and OR were found in the MEDLINE, LILACS, Embase and Cochrane databases. A flowchart with exclusion criteria and inclusion strategy using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, and eligibility criteria was used. Data were extracted regarding the type of study, the applied dosage, treatment time, segment, bias risks, and the Patient, Intervention, Comparison and Outcome (PICO) strategy to identify the quality of the study. Selection of Studies Total number of journals in the initial search (n= 824); exclusions from repeated articles on different search engines (n= 253); exclusions after reading the titles, when the title had no correlations with the proposed theme (n= 164); exclusions due to incompatibility with the criteria established in the methodological analysis (n= 185), exclusion of articles with lower correlation with the objective of the present study (n= 187); and final bibliographic selection (n= 35). Data Collection At first, a systematic review of the literature was performed. Subsequently, from the main selection, randomized and non-randomized trials with metformin that presented their results in absolute and relative numbers of PE outcomes were selected. The variables were treated statistically in the meta-analysis with the Review Manager software (RevMan), version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration. Denmark in the Hovedistaden region. Synthesis of Data The study showed that metmorfin presented greater preventive effects for pregnancy-induced hypertension and was less effective for PE. Conclusion Metformin may gain place in preventive treatments for PE, once the dosages, the gestational age, and treatment time are particularly evaluated. A methodological strategy with an improved perspective of innovative and/or carefully progressive dosages during pregnancy to avoid side effects and the possibility of maternal-fetal risks is suggested.

摘要·研究目的：二甲双胍（metformin）的使用是否会对子痫前期（preeclampsia, PE）的临床结局产生影响？
数据来源：以布尔运算符AND、OR组合检索词“妊娠、二甲双胍、治疗、子痫前期”，在MEDLINE、LILACS、Embase及Cochrane数据库中开展文献检索。采用系统评价与Meta分析优先报告条目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA）规范，结合文献纳入排除标准与资格判定准则，绘制文献筛选流程图。提取的文献数据涵盖研究类型、给药剂量、治疗时长、干预阶段、偏倚风险，以及用于评估研究质量的患者（Patient）、干预措施（Intervention）、对照措施（Comparison）、结局指标（Outcome, PICO）策略。
文献筛选：初始检索共获取期刊文献824篇；因不同搜索引擎间重复文献排除253篇；阅读标题后，排除与本研究主题无关联的文献164篇；因不符合方法学分析预设标准排除185篇；排除与本研究目标相关性较低的文献187篇；最终纳入合格文献35篇。
数据采集：首先开展系统性文献综述。随后从初步筛选后的文献中，遴选采用二甲双胍干预、且以绝对数与相对数形式报告子痫前期结局的随机对照试验与非随机对照试验。采用Review Manager软件（RevMan）5.3版（丹麦哥本哈根首都大区北欧科克伦中心，科克伦协作网出品）对相关变量进行Meta分析统计学处理。
数据综合分析：本研究结果显示，二甲双胍对妊娠高血压具有更显著的预防效果，但对子痫前期的预防效果相对较弱。
研究结论：若能针对性评估给药剂量、妊娠孕周及治疗时长，二甲双胍可被纳入子痫前期的预防治疗方案。本研究建议采用更具创新性或经过严谨优化的给药剂量策略应用于妊娠期，以规避不良反应及母婴双方的潜在风险。