Palabras clave
Manejo de la obesidad
Agonistas GLP-1
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Resumen
Objetivo: Evaluar la eficacia y seguridad del uso de agonistas del GLP-1 (GLP-1A) en mujeres con sobrepeso/obesidad que planean un embarazo. Métodos: Se trata de una revisión sistemática, cuyos ensayos clínicos aleatorizados (ECA) fueron obtenidos en las bases de datos National Library of Medicine, Biblioteca Virtual en Salud y Ovid Cochrane Central RegisterofControlledTrials, filtrados con el software Rayyan y evaluados según el esquema propuesto por Jadad et al. (1996). Resultados: Los ECA que conformaron la muestra abordan desenlaces metabólicos/reproductivos sobre el uso de GLP-1A en mujeres con sobrepeso/obesidad en el período previo a la gestación. Solo tres estudios abordaron las reacciones adversas obstétricas. En dichos estudios, los GLP-1A fueron descritos como seguros y asociados a una menor frecuencia de eventos adversos. Además, el uso de agonistas del GLP-1 demostró una mayor eficacia cuando se asoció con otros medicamentos utilizados para mejorar las funciones metabólicas y reproductivas en esta población. Consideraciones finales: A pesar de la variedad terapéutica y de los indiscutibles beneficios metabólicos y reproductivos de la terapia con GLP-1A en mujeres con sobrepeso/obesidad en planificación familiar, el número de ECA que abordan los desenlaces de seguridad obstétrica es reducido y, en su mayoría, presentan una muestra pequeña, manteniendo el impasse en la implementación de esta terapia.
Referencias
ASKIE L, OFFRINGA M. Systematic reviews and meta-analysis. Seminars in Fetal and Neonatal Medicine, 2015; 403-409.
BAYS HE, et al. Obesity algorithm eBook, presented by the Obesity Medicine Association, 2021.
BELL GI, et al. Exon duplication and divergence in the human preproglucagon gene. Nature, 1983; 304 (5924): 368-371.
DAO K, et al. Use of GLP1 receptor agonists in early pregnancy and reproductive safety: a multicenter, observational, prospective cohort study based on the databases of six Teratology Information Services. BMJ open, 2024; 14(4): e083550.
ELKIND-HIRSCH KE, et al. Postpartum treatment with liraglutide in combination with metformin versus metformin monotherapy to improve metabolic status and reduce body weight in overweight/obese women with recent gestational diabetes: a double-blind, randomized, placebo-controlled study. Journal of Diabetes and its Complications, 2020; 34(4): 107548.
FERJAN S, et al. Dipeptidyl peptidase-4 inhibitor sitagliptin prevented weight regain in obese women with polycystic ovary syndrome previously treated with liraglutide: a pilot randomized study. Metabolic syndrome and related disorders, 2017; 15(10): 515-520.
FOGHSGAARD S, et al. Liraglutide treatment for the prevention of glucose tolerance deterioration in women with prior gestational diabetes mellitus: a 52‐week randomized controlled clinical trial. Diabetes, Obesity and Metabolism, 2024; 26(1):201-214.
GAMBINERI A, et al. “Female infertility: which role for obesity?”.International journal of obesity supplements, 2019; 9(1): 65-72.
GARVEY W, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocrine Practice, 2016; 22: 1-203.
GBD 2019 RISK FACTOR COLLABORATORS. Global Burden of 87 Risk Factors in 204 Countries and Territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet, 2020; 396: 1223–1249.
IMBROANE MR, et al. Preconception GLP-1 Receptor Agonist Use Associated with Decreased Risk for Adverse Obstetric Outcomes. American Journal of Obstetrics and Gynecology, 2025.
JADAD AR, et al. “Assessing the quality of reports of randomized clinical trials: is blinding necessary?”. Control Clin Trials, 1996; 17: 1-12.
JENSEN MD, et al. 2013 AHA/ACC/TOSS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation, 2014; 129(25): S102-S138.
JENSTERLE M, et al. The role of glucagon-like peptide-1 in reproduction: from physiology to therapeutic perspective. Human reproduction update, 2019; 25(4): 504-517.
JUNGHEIM ES, MOLEY KH. Current knowledge of obesity's effects in the pre-and periconceptional periods and avenues for future research. American journal of obstetrics and gynecology,2010; 203(6): 525-530.
KASUM M, et al. The role of female obesity on in vitro fertilization outcomes. Gynecological endocrinology, 2018; 34 (3): 184-188.
LI R, et al. Effect of metformin and exenatide on pregnancy rate and pregnancy outcomes in overweight or obese infertility PCOS women: long-term follow-up of an RCT. Archives of Gynecology and Obstetrics, 2022; 306(5): 1711-1721.
LIU X, et al. Efficacy of exenatide on weight loss, metabolic parameters and pregnancy in overweight/obese polycystic ovary syndrome. Clinical endocrinology, 2017; 8 (6):767-774.
MODARRES SZ, et al. Comparative evaluation of metformin &sitaformin in classic PCOS patients undergoing intracytoplasmic sperm injection: A randomized controlled pilot study. Indian Journal of Medical Research, 2023; 157(1): 66-73.
OUZZAN M, et al. Rayyan—a web and mobile app for systematic reviews. Systematic reviews, 2016; 5:1-10.
PALMA JCP, et al. Comparative treatment between sitagliptin vs. metformin, alone or in combination, in patients with polycystic ovary syndrome. A clinical entity at high risk for developing diabetes mellitus and gestational diabetes: A pilot study. Revista Medica del Hospital General de Mexico,2018; 81(1): 15-26.
NAUCK MA, MEIER JJ. Incretin hormones: Their role in health and disease.Diabetes, Obesity and Metabolism, 2018; 20: 5-21.
NISHIYAMA Y, et al. Incretins modulate progesterone biosynthesis by regulating bone morphogenetic protein activity in rat granulosa cells. The Journal of Steroid Biochemistry and Molecular Biology, 2018; 178: 82-88.
NOMMSEN-RIVERS L, et al. Feasibility and acceptability of metformin to augment low milk supply: a pilot randomized controlled trial. Journal of Human Lactation, 2019; 35(2): 261-271.
OKUNOGBE A, et al.Economic Impacts of Overweight and Obesity.2nd Edition with Estimates for 161 Countries. World Obesity Federation, 2022.
RAMLAU-HANSEN CH, et al. Subfecundity in overweight and obese couples. Human reproduction, 2007; 22 (6): 1634-1637.
SALAMUN V, et al. Liraglutide increases IVF pregnancy rates in obese PCOS women with poor response to first-line reproductive treatments: a pilot randomized study. European journal of endocrinology, 2018; 179 (1): 1-11.
VAN DER STEEG JW, et al. Obesity affects spontaneous pregnancy chances in subfertile, ovulatory women. Human reproduction, 2008; 23(2): 324-328.
YUMUK V, et al. European guidelines for obesity management in adults. Obesity facts, 2015; 8(6): 402-424.
ZHANG S. Effect of liraglutide combined with clomiphene on serum sex hormone levels and natural conception rate in obese women with polycystic ovary syndrome. Chinese Journal of Primary Medicine and Pharmacy, 2020.