妊娠早期2型糖尿病孕妇使用胰高血糖素样肽-1受体激动剂的疗效和安全性

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2025-03-17 DOI:10.1016/j.amjcard.2025.03.013

Muhammad Hanif MBBS , Allison G. Hays MD , Jai S. Nagarajan MBBS , Shiva P. Sah MBBS , Ruth S. Weinstock MD PhD , Cynthia C. Taub MD, MBA

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引用次数: 0

摘要

胰高血糖素样肽1受体激动剂（GLP-1 RAs）是一类较新的抗糖尿病药物，已被证明对减轻体重和改善心脏代谢状况有益。文献显示，成人2型糖尿病（T2D）人群停用GLP-1 RAs后，血糖控制恶化，心血管结局风险增加；然而，在妊娠早期暴露于GLP-1 RAs并随后停药的影响尚不清楚。目的探讨GLP-1 RAs暴露于T2D早孕期人群后的母胎临床结局。方法本回顾性队列研究基于超过1.4亿患者的全球电子健康记录（EHRs）数据库。经倾向评分匹配（PSM）后，研究人群包括3652名T2D女性，根据她们在早期妊娠诊断前1年和诊断后1个月的GLP-1 RAs暴露情况分为2组。t2dm患者早期妊娠诊断前1年及诊断后1个月内GLP-1 RAs暴露情况结果在3652例妊娠早期T2D人群中，GLP-1 RAs暴露队列的平均年龄为36.2岁。在42周的随访后，暴露于GLP-1 ras的孕早期妊娠队列的产妇全因死亡率的主要结局与对照队列相当。妊娠期间暴露于GLP-1 RAs的T2D妇女的继发性产妇结局，即妊娠期高血压、先兆子痫和子痫，在42周的随访后也与对照组相比具有可比性。同样，胎儿心脏和肾脏异常的相对风险在队列之间具有可比性。结论在本研究中，暴露于GLP-1 RAs在妊娠前三个月的T2D。

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Efficacy and Safety of Glucagon-like Peptide-1 Receptor Agonist Use During the First Trimester in Pregnant Women With Type 2 Diabetes

Background

Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are a newer class of antidiabetic drugs that have proven beneficial in reducing weight loss and improving cardiometabolic profile. Literature has shown worsened glycemic control and increased risk of cardiovascular outcomes after stopping GLP-1 RAs in the adult type 2 diabetes (T2D) population; however, the effect of exposure to GLP-1 RAs in first-trimester pregnancy, followed by discontinuation, is still unclear.

Objective

To evaluate the maternal and fetal clinical outcomes after exposure of GLP-1 RAs in a T2D first-trimester pregnant population.

Methods

This retrospective cohort was based on a global database of electronic health records (EHRs) of more than 140 million patients. After propensity score matching (PSM), the study population included 3,652 women with T2D, divided into 2 cohorts based on their exposure to GLP-1 RAs within 1 year before and 1 month after diagnosis of first-trimester pregnancy. Exposure to GLP-1 RAs within 1 year before and 1 month after diagnosis of first-trimester pregnancy in T2D women.

Results

In this study of a 3,652 first-trimester T2D population, the average age of the GLP-1 RAs exposed cohort was 36.2 years. The primary outcome of the maternal all-cause mortality rate was comparable in the GLP-1 RAs-exposed first-trimester pregnant cohort compared to the control cohort after 42 weeks of follow-up. Secondary maternal outcomes, i.e., gestational hypertension, preeclampsia, and eclampsia, were also comparable after 42 weeks of follow-up in the women with T2D exposed to GLP-1 RAs during their pregnancy as compared to the control. Similarly, the relative risk of fetal cardiac and kidney anomalies was comparable between the cohorts.

Conclusion

In this study, exposure to GLP-1 RAs during the first trimester of pregnancy in T2D.

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来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.