The effect of dipeptidyl peptidase-4 inhibitor and glucagon-like peptide-1 receptor agonist in gestational diabetes mellitus: a systematic review

Gestational diabetes mellitus (GDM) is the most common complication in pregnancy and affects 13% pregnant women around the world. GDM has both short-term and long-term negative effect on mother and offspring. Dipeptidyl peptidase-4 (DPP-4) inhibitor and glucagon-like peptide-1 receptor agonist (GLP-1 Ra) have shown many extra-benefits in diabetes patients, and may be a promising choice to GDM. Here, we conducted a systematic review of randomized controlled trials to investigate the effect of DPP-4 inhibitor and GLP-1 Ra in GDM. This project was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement. We searched PubMed, EMBASE and Cochrane library up to November 8 2019 for eligible trials. A total of 982 records were identified and 4 trials (516 participants) met the criteria in the end. The results suggested that DPP-4 inhibitor and GLP-1 Ra can reduce the rate of developing postpartum diabetes, help to normalization of blood glucose and improve insulin resistance and β-cell function. Although the treatments showed beneficial effects in GDM patients, but the present data could not prove it use in GDM. Further clinical trials will be needed.

妊娠糖尿病（Gestational diabetes mellitus, GDM）是妊娠期最常见的并发症，全球范围内约有13%的孕妇罹患该病。GDM对孕产妇及子代均存在短期与长期的不良影响。二肽基肽酶-4（Dipeptidyl peptidase-4, DPP-4）抑制剂与胰高血糖素样肽-1受体激动剂（glucagon-like peptide-1 receptor agonist, GLP-1Ra）在糖尿病患者中已被证实具备诸多额外获益，或可为GDM的治疗提供极具前景的选择。本研究针对随机对照试验开展系统评价，以探究DPP-4抑制剂与GLP-1Ra用于GDM患者的治疗效果。本项目严格遵循《系统评价与Meta分析优先报告条目》（Preferred Reporting Items for Systematic Reviews and Meta Analyses, PRISMA）声明实施。我们检索了截至2019年11月8日的PubMed、EMBASE及考克兰文库（Cochrane Library）数据库，筛选符合纳入标准的试验。最终共检索到982条相关记录，最终仅有4项试验（合计516名受试者）符合纳入标准。研究结果显示，DPP-4抑制剂与GLP-1Ra可降低产后糖尿病的发生风险，有助于血糖恢复正常，并能改善胰岛素抵抗及β细胞功能。尽管上述治疗方案在GDM患者中展现出有益效果，但现有数据尚不足以支持其在GDM临床中的应用，仍需开展进一步的临床试验。