时间标签：数据日期 2026-10-31 · 生成时间 2026-11-01 05:30（Asia/Shanghai）｜ 检索窗口 PubMed edat 2026/10/28–2026/10/31 ｜ 情报发生日期 2026-10-31
研究问题
However, insulin therapy still faces several challenges in real-world practice, including increased treatment costs and higher risk of hypoglycemia [, ].；However, the effectiveness and safety of metformin during pregnancy remain subjects of debate.；Therefore, this study aimed to evaluate glycemic control and the risk of adverse pregnancy outcomes between the insulin initiation group and the metformin initiation group among women with GDM.
方法
Eligible patients met the following criteria.；The follow-up period commenced on the index date and continued until the end of pregnancy, loss to follow-up, death, or the database cutoff date (October 31, 2025), whichever occurred first.；According to the type of the first prescription of glucose-lowering medications during pregnancy, participants were divided into two independent and mutually exclusive exposure groups: the insulin-initiation group (control group) and the metformin-initiation group.；Baseline characteristics were described descriptively across treatment cohorts.
核心结论
Before weighting, most baseline covariates showed significant differences between the two groups (SMD > 0.1, Table ).；Compared with the metformin initiation group, the insulin initiation group had a lower gestational week at enrollment (26.0 weeks vs. 28.4 weeks, SMD = 0.27) and a higher HbA1c level (6.4% vs. 5.6%, SMD = 0.64).；The proportion of multiparous women (number of dependent children ≥ 1) was higher in the insulin initiation group (23.8% vs. 8.0%, SMD = 0.44), and the proportion of married patients was also higher (72.9% vs. 44.2%, SMD = 0.61). ‖ 结论：While these results advocate for more individualized management in GDM, further high-quality prospective studies and long-term follow-up are warranted to evaluate the short- and long-term effects of these treatment strategies on maternal and neonatal health outcomes.
局限
Although this study adjusted for parity in the weighted model, residual confounding from unobserved factors such as delivery preference cannot be completely excluded.；Firstly, it leveraged a large electronic medical record database from China, enhancing the generalizability of the findings and real-world representativeness.；Several limitations should be considered.
对本项目的价值
★☆☆☆☆ 代谢轴既干预敏感性最高，也是老药新用供给最充足的来源。最大样本量约 7,397。
全文来源
PMC JATS 全文（正文 27,192 字符，已过标题/DOI 逐字归属校验）
原文题录
- 英文标题：Comparative effectiveness of initiating insulin versus metformin therapy for gestational diabetes mellitus in China: a retrospective cohort study.
- 期刊与标识：BMC Pregnancy Childbirth · PMID 42947081 · DOI 10.1186/s12884-026-09752-4
A 级证据分级：A 级（同行评议人体研究）
本文属人体研究证据，但需注意：观察性或小样本干预的结论不等于已证实临床获益；效应量与长期安全性仍需更大规模、更长随访的试验验证。
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