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

Abstract

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.