| Background :Polycystic ovary syndrome(PCOS)is a common reproductive and endocrine disorders affecting women in reproductive age,the pregnancy outcomes could be effected by the abnormalities of hormone and metabolism significantly.Some scholars have contended that hyperinsulinemia had an adverse effect on endometrial function and embedded environment,moreover,it could increase the possibility of pregnancy complications,for example,early pregnancy loss,premature delivery,pregnancy-induced hypertension,etc.In addition,the studies have showed that the incidence of impaired glucose tolerance(IGT)or type 2 diabetes mellitus(T2DM)in PCOS patients was obviously higher than which in normal people.In view of PCOS patients with diabetes mellitus(DM)being in a state of pregnancy,coupled with the increased amount of estrogen and progesterone in the pregnant women,which could cause worse insulin resistance,it is difficult for them to control blood glucose compared to those normal patients with type 2 diabetes mellitus and it is vulnerable for them to get the adverse pregnant and neonatal outcomes.Controling blood glucose during pregnancy mainly by improving the diet,lifestyle and monitoring blood glucose by oneself.If someone cannot control it effectively,the insulin therapy is preferred.However,it is still controversial whether oral hypoglucose drugs can be used for glycemic controling during pregnancy.In recent years,some studies have found that continuing metformin throughout pregnancy in women with PCOS can reduce abortion,premature delivery,pregnancy-induced hypertension and other adverse pregnancy outcomes,and more attention have be given to metformin during pregnancy,which has become a hot topic in the world.Objcetive:The purpose of this paper is researching the effect of the outcomes of maternal,fetal and neonatal about continuing therapy with metformin throughout pregnancy in women with PCOS who combined T2 DM,so that we can weigh the pros and cons of metformin in curing those patients,and provide better glycemic control program for these patients,avoiding adverse maternal and fetal and neonatal outcomes.Methods:Ninety-seven pregnant women who met the inclusion and exclusion criterias of PCOS with type 2 diabetes mellitus were included from October 2015 to April 2017 in the endocrinology department of the Second Hospital of Jilin University.The patients were divided into observation group(n=43)and control group(n=54)in random.The observation group was given metformin combined with insulin treatment,and the control group was given only insulin treatment.All patients were informed and signed the informed consent,conducted diet and exercise education guidance.All patients were followed-up at one time a month until the fetal birth,including observing the blood glucose,timely adjusting the dose of metformin and insulin according to the changes of blood glucose,measuring obstetric ultrasound and urine protein.Compare the fasting glucose(FPG),2 hours after postprandial glucose(2hPG),insulin doses and Glycosylated hemoglobin(HbA1c)between the two groups.Observe the pregnant outcomes and neonatal complications,the former included the rates of gestational hypertension,proteinuria,preeclampsia,amniotic fluid increased,miscarriage and cesarean section,the latter included the rates of premature delivery,neonatal hypoglycemia,macrosomia,neonatal death,and neonatal birth weight,birth malformation,Apgar-score at five minutes of birth.Results:1.In the three month of pregnancy,there was no statistically significant difference between the observation group and the control group on FPG,2hPG,insulin dose and HbA1c(P>0.05).In the six month of pregnancy and delivery,FPG,2hPG,insulin dose and HbA1 c were all significantly lower than the control group in the observation group(P<0.05).2.The adverse pregnant outcomes appeared in two groups of pregnant women were as follows,the proportion of gestational hypertension(5.7%vs25.6%,P=0.019)and proteinuria(11.4% vs37.2 %,P = 0.010),preeclampsia(5.7%vs23.3%,P= 0.033),and amniotic fluid increased(11.4%vs34.9%,P= 0.016),miscarriage(5.6%vs20.8%,P=0.048),cesarean section(11.8% vs31.6 %,P= 0.043)were lower than the control group in the observation group,and the difference was statistically significant(P<0.05).3.The neonatal outcomes appeared in two groups were as follows,two cases premature infants were observed in the observation group,and ten cases premature infants in the control group(5.9%vs26.3%,P=0.020).In the observation group,one case hypoglycemia was observed in the neonates,which was less than the control group in which seven cases were observed(2.9%vs18.4%,P=0.037).In the observation group,there were three cases large children(8.8%),average weight was 3.58 ± 0.35 kg,and eleven cases in the control group(28.9%),with an average weight of 3.80 ±0.43kg(P=0.031;P= 0.018);In the observation group,Apgar-score at five minutes of birth was higher than the control group(P=0.006).There was no significant difference between the two groups in birth malformation and neonatal death(P>0.05).Conclusion:Continuing metformin combined insulin throughout pregnancy in women with PCOS who suffering with T2 DM have a better glycemic control than those treated with simple insulin,and can avoid adverse pregnant,fetal and neonatal outcomes,as well as can't increase neonatal death and malformation. |
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