Drugs to Control Diabetes During Pregnancy

Abstract

Diabetes is a common complication of pregnancy associated with both short-and long-term adverse maternal and offspring effects. All types of diabetes in pregnancy are increasing in prevalence. Treatment of diabetes in pregnancy, targeting glycemic control, improves both maternal and offspring outcomes, albeit imperfectly for many women. Pharmacologic treatment recommendations differ between pre-gestational and gestational diabetes; in each case, effectiveness appears limited by co-morbid obesity due to overlapping maternal and offspring risks associated with obesity and diabetes in pregnancy. Despite changes in patient characteristics and increasing evidence of heterogeneous pathophysiology contributing to diabetes in pregnancy, current practice still presupposes a single common treatment strategy, including pharmacologic agents and glycemic targets, with little distinction by diabetes type or pathophysiologic mechanism. Furthermore, while diabetes in pregnancy is associated with long-term offspring risks, few studies have assessed long-term outcomes following exposure to different diabetes treatments in utero. Improved treatment of diabetes in pregnancy will need to consider maternal disease heterogeneity and comorbidities as well as long-term offspring outcomes. In this review, we will summarize recent clinical studies to highlight established pharmacologic treatments for diabetes in pregnancy and provide suggestions for further research.

Perinatal factors impacting echocardiographic left ventricular measurement in small for gestational age infants: a prospective cohort study

“…IGF-1 stimulates cardiomyocyte hypertrophy, resulting in reduced myocardial compliance and functional impairment [ 37 , 38 ]. Nonetheless, the usage of insulin may be an indication of poor glycemic control, which may be a potential confounder in this scenario that leads to IVSd enlargement [ 39 ].…”

High glucose inhibits neural differentiation by excessive autophagy <em>via</em> peroxisome proliferator-activated receptor gamma

“… 45 This approach has been used in a variety of studies to investigate various aspects of neuronal development, function, and disease. 46 The cells were maintained in Eagle’s Minimum Essential Medium (#30-2003 from ATCC), supplemented with 2 mM L-Glutamine (Beyotime, Shanghai, China) and 10% (v/v) fetal bovine serum (FBS; Gibco, MA, USA) at 37°C with 5% CO 2 .…”

“…Neural differentiation was initiated by the introduction of 0.5 μM all-trans retinoic acid (RA; Sigma-Aldrich, St. Louis, MO, USA), as previously described. 47 Additionally, cells were maintained with a formulated medium containing Minimum Essential Medium (Sigma-Aldrich), 5% fetal bovine serum (Gibco), and 4 mM glutamine (Sigma-Aldrich) at 37°C with 5% CO 2 . Differentiated cells were collected at day 1, 2, 3, and 4 for RT-PCR gene expression analysis, and cell morphology was observed by a phase-contrast microscope (IX81, Olympus, Hamburg, Germany).…”

As Competências Do Enfermeiro Diante Dos Problemas Gerados a Saúde Da Mulher E Da Criança Pela Diabetes Gestacional

“…Dos casos de complicações na gravidez 90% é ocasionado pela diabetes gestacional, As alterações fisiológicas da gravidez como o aumento da resistência insulínica, ganho de peso gestacional e alterações na composição corporal podem dificultar o tratamento da diabetes na gravidez. (Feghali. et al / 2019) A diabetes é uma das complicações mais comuns entre as gestações de alto risco.…”

“…Entretanto, no final da gestação, há uma diminuição na sensibilidade insulínica, normalizando os índices glicêmicos. (Feghali. et al / 2019) Alguns autores defendem que as gestantes desenvolvem resistência à insulina para fornecer um desenvolvimento adequado e energia suficiente para o feto.…”