Prevalence, Trends, and Patterns of Use of Antidiabetic Medications Among Pregnant Women, 2001-2007

Lawrence, Jean M.; Andrade, Susan E.; Avalos, Lyndsay A.; Beaton, Sarah J.; Chiu, Vicki; Davis, Robert L.; Dublin, Sascha; Pawloski, Pamala A.; Raebel, Marsha A.; Smith, David H.; Toh, Sengwee; Wang, Jean Q.; Kaplan, Sigal; Amini, Thushi; Hampp, Christian; Hammad, Tarek A.; Scott, Pamela E.; Cheetham, T. Craig

doi:10.1097/aog.0b013e318278ce86

Cited by 25 publications

(24 citation statements)

References 26 publications

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“…This trend was coincident with the publication of results from randomized clinical trials (9–11) and observational studies (12–14, 20). Our results support findings from recent studies showing widespread use of glyburide despite lack of conclusive clinical evidence being available (3, 21). This trend need to be interpreted in the light of changes in GDM diagnosis and initiation of pharmacotherapy in this population over time.…”

Section: Discussionsupporting

confidence: 91%

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Trends in Glyburide Compared With Insulin Use for Gestational Diabetes Treatment in the United States, 2000–2011

Castillo

Boggess

Stürmer

et al. 2014

Obstetrics &Amp; Gynecology

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Objective To describe trends and identify factors associated with choice of pharmacotherapy for gestational diabetes (GDM) from 2000–2011 using a healthcare claims database. Methods This was a retrospective cohort study of a large nationwide population of commercially insured women with GDM and pharmacy claims for glyburide or insulin prior to delivery, 2000–2011. We excluded women younger than 15 years or older than 50 years, those with prior type 2 diabetes, or those who had multiple gestations. We estimated trends over time in the use of glyburide compared with insulin and prevalence ratios (PR) and 95% confidence intervals (CI) for the association between covariates of interest and treatment with glyburide compared with insulin. Results We identified 10,778 women with GDM treated with glyburide (n=5,873) or insulin (n=4,905). From 2000–2011, glyburide use increased from 7.4% to 64.5%, becoming the more common treatment in 2007. Women less likely to be treated with glyburide were those with metabolic syndrome (PR=0.71, 95%CI: 0.50– 0.99), hyperandrogenism (PR=0.77, 95%CI: 0.62–0.97), polycystic ovarian syndrome (PR=0.88, 95%CI: 0.78–0.99), hypothyroidism (PR=0.89, 95%CI: 0.83–0.96) or undergoing infertility treatment (PR=0.93, 95%CI: 0.86–1.02). The probability of receiving glyburide decreased by 5% for every 10-year increase in maternal age (PR=0.95, 95%CI: 0.91–0.99). Among women prescribed with glyburide, 7.8% switched or augmented to a different drug class compared with 1.1% of insulin initiators. Conclusion Glyburide has replaced insulin as the more common pharmacotherapy for GDM over the last decade among those privately insured. Given its rapid uptake and the potential implications of suboptimal glucose control on maternal and neonatal health, robust evaluation of glyburide’s relative effectiveness is warranted to inform treatment decisions for women with gestational diabetes.

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Section: Discussionsupporting

confidence: 91%

“…Between 7–35% of diagnosed women will require pharmacological treatment during pregnancy (1). The only Food and Drug Administration approved medication for the treatment of GDM is insulin (2) although glyburide (an oral agent), is also used (3). …”

Section: Introductionmentioning

confidence: 99%

Trends in Glyburide Compared With Insulin Use for Gestational Diabetes Treatment in the United States, 2000–2011

Castillo

Boggess

Stürmer

et al. 2014

Obstetrics &Amp; Gynecology

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“…The prevalence of GDM has considerably increased in recent years . At the same time, the number of patients for whom lifestyle modifications alone failed in achieving adequate postprandial glucose targets and, therefore, requiring drug therapy for GDM, also rose, which was also seen in our study, with a significant increase between 2008 and 2012. This development awakens interest in gaining more information on antidiabetic drug therapy in pregnancy, which was the focus of the present study.…”

Section: Discussionsupporting

confidence: 76%

“…While sulfonylureas are the most commonly applied oral antidiabetics in GDM in the USA, these medications are rarely used in Germany for this indication, and this is also reflected in our study with a proportion of only 0.2%. Contrary to that, the use of metformin grew considerably in Germany in recent years (also detected in our study) due to its additional advantages when compared to both insulin and sulfonylurea: it does not lead to maternal hypoglycemia, ameliorates insulin sensitivity, and is not accompanied by weight gain .…”

Section: Discussionmentioning

confidence: 68%

Use of antidiabetic agents in the treatment of gestational diabetes mellitus in Germany, 2008–2012

Heilmaier

Thielscher

Ziller

et al. 2014

J of Obstet and Gynaecol

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Aim: Adequate blood glucose control during pregnancy is important because gestational diabetes mellitus (GDM) is known to have adverse effects on the mother and child. Due to an increasing prevalence of GDM in recent years, more information on the use of different antidiabetic agents is required, which was the aim of the present study. Material and Methods: Data from 32 diabetic practices in Germany were collected from January 2008 to December 2012 and analyzed using the Disease Analyzer Database. All women with International Classification of Diseases diagnosis O24 (that is, GDM) participated, except for patients with known type I or II diabetes mellitus, who were excluded. Analysis focused on the proportion of women requiring drug treatment in general. Thereafter, subanalysis was performed with a focus on the administration of different antidiabetic agents, namely insulin, metformin, and sulfonylurea. Results: Within the given timeframe, medication-based treatment for GDM significantly rose to reach 30.8% of all women with GDM. Both the administration of insulin and metformin grew considerably within the 5-year period with metformin being increasingly used without supplemental insulin and at lower dosages. Within the insulin treatment arm, insulin analogues became increasingly important. The proportion of sulfonylurea remained stable (0.2%). Conclusions: GDM is more often treated with antidiabetic agents and, due to the fact that metformin is more frequently prescribed, it can be assumed that it is increasingly regarded as a safe and effective alternative to insulin.

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“…Drug exposure during pregnancy in Western Europe and US is reported to have increased in the past 10 years [5, 6]. In most developing countries, where proper drug monitoring system during pregnancy does not exist, it is difficult to know the magnitude of drug exposure in pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Medication exposure during pregnancy: a pilot pharmacovigilance system using health and demographic surveillance platform

Mosha

Mazuguni

Mrema

et al. 2014

BMC Pregnancy Childbirth

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BackgroundThere is limited safety information on most drugs used during pregnancy. This is especially true for medication against tropical diseases because pharmacovigilance systems are not much developed in these settings. The aim of the present study was to demonstrate feasibility of using Health and Demographic Surveillance System (HDSS) as a platform to monitor drug safety in pregnancy.MethodsPregnant women with gestational age below 20 weeks were recruited from Reproductive and Child Health (RCH) clinics or from monthly house visits carried out for the HDSS. A structured questionnaire was used to interview pregnant women. Participants were followed on monthly basis to record any new drug used as well as pregnancy outcome.Results1089 pregnant women were recruited; 994 (91.3%) completed the follow-up until delivery. 98% women reported to have taken at least one medication during pregnancy, mainly those used in antenatal programmes. Other most reported drugs were analgesics (24%), antibiotics (17%), and antimalarial (15%), excluding IPTp. Artemether-lumefantrine (AL) was the most used antimalarial for treating illness by nearly 3/4 compared to other groups of malaria drugs. Overall, antimalarial and antibiotic exposures in pregnancy were not significantly associated with adverse pregnancy outcome. Iron and folic acid supplementation were associated with decreased risk of miscarriage/stillbirth (OR 0.1; 0.08 – 0.3).ConclusionAlmost all women were exposed to medication during pregnancy. Exposure to iron and folic acid had a beneficial effect on pregnancy outcome. HDSS proved to be a useful platform to establish a reliable pharmacovigilance system in resource-limited countries. Widening drug safety information is essential to facilitate evidence based risk-benefit decision for treatment during pregnancy, a major challenge with newly marketed medicines.

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Prevalence, Trends, and Patterns of Use of Antidiabetic Medications Among Pregnant Women, 2001-2007

Cited by 25 publications

References 26 publications

Trends in Glyburide Compared With Insulin Use for Gestational Diabetes Treatment in the United States, 2000–2011

Trends in Glyburide Compared With Insulin Use for Gestational Diabetes Treatment in the United States, 2000–2011

Use of antidiabetic agents in the treatment of gestational diabetes mellitus in Germany, 2008–2012

Medication exposure during pregnancy: a pilot pharmacovigilance system using health and demographic surveillance platform

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