Diabetic Medications in Pregnancy

Young, James; Anwar, Attia

doi:10.2174/157339909789804350

Cited by 8 publications

(7 citation statements)

References 56 publications

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“…PPARγ plays a role in placental maturation and may regulate placental fatty acid transport and storage and hormone secretion . Although thiazolinediones do not appear to be teratogenic, they readily cross the placenta and their use has been associated with fetal death and growth retardation, secondary to placental dysfunction.…”

Section: Thiazolidinedionesmentioning

confidence: 99%

“…As they reduce postprandial hyperglycaemia and less than 2% is absorbed (although drug metabolites may appear in the maternal circulation), these agents may have potential benefits in pregnancy. Animal studies have suggested no harmful effects, but there are scanty data of its use in human pregnancy . There are theoretical concerns that the reduced carbohydrate absorption may alter bowel flora and alter inflammation or prostaglandin E secretion, with the potential to induce labour.…”

Section: Alpha‐glucosidase Inhibitorsmentioning

confidence: 99%

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The use of oral hypoglycaemic agents in pregnancy

Holt

Lambert

2014

Diabet. Med.

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While insulin has been the treatment of choice when lifestyle measures do not maintain glycaemic control during pregnancy, recent studies have suggested that certain oral hypoglycaemic agents may be safe and acceptable alternatives. With the exception of metformin and glibenclamide (glyburide), there are insufficient data to recommend treatment with any other oral hypoglycaemic agent during pregnancy. There are no serious safety concerns with metformin, despite it crossing the placenta. When used in the first trimester, there is no increase in congenital abnormalities and there appears to be a reduction in miscarriage, pre-eclampsia and subsequent gestational diabetes. Studies of the use of metformin in gestational diabetes show at least equivalent neonatal outcomes, while reporting reductions in neonatal hypoglycaemia, maternal hypoglycaemia and weight gain and improved treatment satisfaction. Glibenclamide effectively lowers blood glucose in women with gestational diabetes, possibly with a lower treatment failure rate than metformin. Although generally well tolerated, some studies have reported higher rates of pre-eclampsia, neonatal jaundice, longer stay in the neonatal care unit, macrosomia and neonatal hypoglycaemia. There is a paucity of long-term follow-up data on children exposed to oral agents in utero. The American College of Obstetrics and Gynecology and the UK National Institute of Health and Care Excellence (NICE) have recommended that either metformin or glibenclamide can be used to treat gestational diabetes. Metformin is also recommended for use in the pre-conception period by NICE. By contrast, the American Diabetes Association recommends that both drugs should only be used during pregnancy in the context of clinical trials.

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Section: Thiazolidinedionesmentioning

confidence: 99%

Section: Alpha‐glucosidase Inhibitorsmentioning

confidence: 99%

The use of oral hypoglycaemic agents in pregnancy

Holt

Lambert

2014

Diabet. Med.

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“…The drug itself is not absorbed in the body. Animal studies have suggested no harmful effects, but at present the use of acarbose is not currently recommended because of the lack of human pregnancy safety data [40]. There are theoretical concerns that the reduced carbohydrate absorption may alter bowel flora causing prostaglandin E secretion, with the potential to induce labor.…”

Section: It Reduces Intestinal Carbohydrate Absorption By Inhibiting mentioning

confidence: 99%

Oral Anti-diabetic Agents as an Alternative Treatment of Diabetes in Pregnancy

Laila¹

2016

AJCEM

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Diabetes is the commonest medical condition in pregnancy. The initial treatment of gestational and Type 2 diabetes in pregnancy is dietary and lifestyle measures. Upon failure of this, pharmacological treatment is advocated which is insulin due to its unparalleled efficacy and safety. But insulin has got some drawbacks like suboptimal patient adherence specially in developing countries. Considering this, studies are done with oral anti-diabetic agents (OAA) among which glyburide and metformin are common. The purpose of this review article is to summarize the different studies done with the OAA specially glyburide and metformin and to critically evaluate the results. Information was collected by searching pub med for related studies, abstracts and articles. Studies on glyburide show little or no transfer across the placenta while metformin cross readily. However animal studies have found no evidence to suggest that glyburide and metformin are teratogenic. In pregnancy glyburide was found to be safe and efficacious with a success rate of 80-85% and there was less incidence of maternal hypoglycemia than insulin. Some studies reported higher rate of preeclampsia, neonatal jaundice and macrosomia. Metformin was associated with reduced neonatal hypoglycemia, maternal hypoglycemia and weight gain with improved treatment satisfaction. However it was observed that failure occurred more with these two drugs in those pregnant women who were early diagnosed cases of gestational diabetes mellitus(<25 weeks), having past history of gestational diabetes mellitus, obese, elderly and with high blood sugar profile specially fasting sample. Prescription of any OAA in pregnancy should be accompanied by full information of the drug including its lack of long term safety data. With the exception of glyburide and metformin there is insufficient data to recommend treatment with any other currently available OAA during pregnancy.

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“…Estudos animais mostraram ausência de teratogenia em doses 32 vezes maiores que a dose terapêutica humana (26). Até o momento, somente um ensaio clínico randomizado com número reduzido de gestantes mostrou efetividade e desfechos semelhantes aos da insulina (30).…”

Section: Acarboseunclassified

“…Até o momento, somente um ensaio clínico randomizado com número reduzido de gestantes mostrou efetividade e desfechos semelhantes aos da insulina (30). Uma potencial restrição ao uso da acarbose poderia ser o risco de aumento de parto pré-termo em decorrência da redução da absorção de carboidratos intestinais, que aumentaria a lise bacteriana e as concentrações de butirato, com consequente aumento na secreção de prostaglandina E e aumento prematuro da atividade uterina (26). Mais estudos são necessários para avaliar a influên-cia da acarbose sobre os desfechos materno-fetais.…”

Section: Acarboseunclassified

Diabetes gestacional: um algoritmo de tratamento multidisciplinar

Weinert

Silveiro

Oppermann

et al. 2011

Arq Bras Endocrinol Metab

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SUMÁRIOO tratamento do diabetes gestacional é importante para evitar a morbimortalidade materno--fetal. O objetivo deste artigo é descrever o tratamento atualmente disponível para o manejo otimizado da hiperglicemia na gestação e sugerir um algoritmo de tratamento multidisciplinar. A terapia nutricional é a primeira opção de tratamento para as gestantes, e a prática de exercício físico leve a moderado deve ser estimulada na ausência de contraindicações obstétricas. O tratamento medicamentoso está recomendado quando os alvos glicêmicos não são atingidos ou na presença de crescimento fetal excessivo à ultrassonografia. O tratamento tradicional do diabetes gestacional é a insulinoterapia, embora mais recentemente a metformina venha sendo considerada uma opção segura e eficaz. A monitorização do tratamento é realizada com aferição da glicemia capilar e com avaliação da circunferência abdominal fetal por meio de ultrassonografia obstétrica a partir da 28 a semana de gestação. INTRODUÇÃOO diabetes gestacional é definido como qualquer grau de redução da tolerância à glicose, cujo início ou detecção ocorre durante a gravidez (1,2). Sua prevalência é variável, dependendo dos critérios diagnósticos empregados e da população estudada (1). No Brasil, em torno de 7% das gestações são complicadas pela hiperglicemia gestacional (3).Habitualmente, o diagnóstico do diabetes gestacional é realizado por busca ativa, com testes provocativos que empregam sobrecarga de glicose, a partir do segundo trimestre da gestação. Mais recentemente, tem-se recomendado a triagem precoce de gestantes de alto risco na primeira consulta pré-natal, o que permite identificar casos de diabetes preexistente e que não devem, portanto, ser rotulados como diabetes gestacional (1,4).

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Diabetic Medications in Pregnancy

Cited by 8 publications

References 56 publications

The use of oral hypoglycaemic agents in pregnancy

The use of oral hypoglycaemic agents in pregnancy

Oral Anti-diabetic Agents as an Alternative Treatment of Diabetes in Pregnancy

Diabetes gestacional: um algoritmo de tratamento multidisciplinar

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