Women with previous gestational diabetes mellitus (GDM) are at increased risk of developing diabetes after pregnancy (DAP), especially 5-10 years postpartum. Two well-known diabetes prevention trials demonstrated a significant reduction in DAP incidence using metformin and troglitazone; however, since their publication, several novel classes of anti-hyperglycemic agents have emerged. This review aimed to conduct a systematic literature search for new evidence in support of pharmacotherapy in DAP prevention and to analyze the results based on special considerations for women of reproductive potential. The only studies whose primary outcome was DAP incidence were those examining metformin, the thiazolidinediones troglitazone and pioglitazone, and the dipeptidyl peptidase-4 inhibitor vildagliptin. Metformin was effective in DAP reduction and was well tolerated, but participants were on average 12 years beyond their GDM pregnancy. Troglitazone was also shown to prevent DAP, but was withdrawn from the market due to hepatotoxicity. There was no comparator arm in the pioglitazone study, which limits its interpretability. The vildagliptin study was underpowered. There are ongoing trials with glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors, but none with diabetes incidence as a primary outcome. This review highlights the limited evidence base for pharmacological prevention of DAP.

中文翻译：

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先前妊娠糖尿病女性孕妇预防妊娠后的药物干预：范围回顾。

先前患有妊娠糖尿病（GDM）的女性在怀孕后（DAP）患糖尿病的风险增加，尤其是产后5-10年。两项著名的糖尿病预防试验表明，使用二甲双胍和曲格列酮可显着降低DAP的发病率。然而，自其发表以来，出现了几种新颖的抗降血糖药。这篇综述的目的是进行系统的文献搜索，以寻找支持DAP预防的药物疗法的新证据，并基于对具有生殖潜力的女性的特殊考虑来分析结果。唯一以DAP发生为主要结果的研究是检查二甲双胍，噻唑烷二酮曲格列酮和吡格列酮以及二肽基肽酶4抑制剂维格列汀的研究。二甲双胍可有效减少DAP，并且耐受性良好，但参与者平均比GDM妊娠高12岁。曲格列酮也被证明可以预防DAP，但由于肝毒性而被撤出市场。吡格列酮研究中没有比较组，这限制了它的可解释性。维格列汀的研究动力不足。目前正在进行有关胰高血糖素样肽1受体激动剂和钠葡萄糖共转运蛋白2抑制剂的试验，但没有一项试验以糖尿病的发生为主要结果。这篇综述强调了DAP药理预防的有限证据基础。吡格列酮研究中没有比较组，这限制了它的可解释性。维格列汀的研究动力不足。目前正在进行有关胰高血糖素样肽1受体激动剂和钠葡萄糖共转运蛋白2抑制剂的试验，但没有一项试验以糖尿病的发生为主要结果。这篇综述强调了DAP药理预防的有限证据基础。吡格列酮研究中没有比较组，这限制了它的可解释性。维格列汀的研究动力不足。目前正在进行有关胰高血糖素样肽1受体激动剂和钠葡萄糖共转运蛋白2抑制剂的试验，但没有一项试验以糖尿病的发生为主要结果。这篇综述强调了DAP药理预防的有限证据基础。