Perinatal outcomes and the use of oral hypoglycemic agents

Bertini, Anna Maria; Silva, Jean Carl; Taborda, Wladimir; Becker, Fernando; Bebber, Fernanda Regina Lemos; Viesi, Juliana Maria Zucco; Aquim, Gabriela; Ribeiro, Thaís Engel

doi:10.1515/jpm.2005.092

Cited by 126 publications

(142 citation statements)

References 17 publications

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“…Another recent study found higher rates of macrosomia and neonatal hypoglycemia in the neonates whose mothers were treated with glyburide. 58 Further, it appears that approximately 20% of women treated with glyburide will fail this management resulting in less time to optimally achieve control with insulin. 56,59,60 Given the lack of further confirmation on the findings regarding the safety and efficacy of glyburide by large, randomized controlled studies and the limitations of observational studies, the ACOG has designated the use of glyburide in pregnancy to be experimental.…”

Section: Use Of Oral Agents Contraindicatedmentioning

confidence: 99%

Gestational diabetes: diagnosis and management

Cheng

Caughey

2008

J Perinatol

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Purpose: To review the diagnosis and management of gestational diabetes.Epidemiology: In the United States, approximately 2 to 5% of all pregnant women have gestational diabetes. Those women with a family history of type 2 diabetes mellitus, Asian or native American race, Latina ethnicity or obesity are at higher risk for developing gestational diabetes. Conclusion:Women with gestational diabetes who are treated appropriately can achieve good outcomes in the majority of pregnancies. Frequent blood glucose monitoring, nutrition counseling and frequent physician contact allow for individualized care to achieve optimal outcomes. Such treatment includes diet, exercise and insulin. The use of oral hypoglycemic agents is controversial and there is some concern about worse maternal and neonatal outcomes as compared to treatment with insulin. Evolving technologies promise to provide more therapeutic options.

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Section: Use Of Oral Agents Contraindicatedmentioning

confidence: 99%

Gestational diabetes: diagnosis and management

Cheng

Caughey

2008

J Perinatol

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“…The rate of large for gestational age fetuses in each group was 3.7%, 25% and 10.5% respectively. [15] At term, in our study, there was 9.1% and 13.1% of babies in acarbose group and insulin groups respectively with birth weight >3.5 kg. Hypoglycaemia was not there in any of the babies from acarbose group while 21.3% of babies had hypoglycemia in the insulin group.…”

Section: Discussionmentioning

confidence: 44%

“…Bertini AM et al found that glucose control was not achieved in 42.1% of patients using Acarbose. [15] Spellacy, WN Miller, S Winegar found that Macrosomia was present in 50% of pregnancies with GDM. [16] Langer et al also found 50% of pregnant patients with GDM to have macrosomia.…”

Section: Discussionmentioning

confidence: 99%

Comparative Study between Acarbose and Insulin in the Treatment of GDM

Sharon¹,

Bashutheen²

2018

AIMDR

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Background: GDM is a condition with predominantly high post prandial blood sugar levels. If left untreated it causes adverse maternal and perinatal outcome. Moreover in the long term most of the GDM mothers become diabetics. Aim: To compare the effectiveness of acarbose and insulin in the treatment of GDM. Methods: A randomized controlled trial was conducted. All antenatal women attending antenatal OPD were screened for GDM using DIPSI guidelines. Medical nutritional therapy was initiated in all screen positive individuals. Glycemic profile was done after two weeks. The individuals with abnormal glycemic profile and who met the inclusion criteria were included in the study. Results: The subjects in both the groups were matched for age, parity and BMI. The average gestational age at which screening was positive was 26 weeks of pregnancy. It was found that that Acarbose is equally effective as insulin in controlling the maternal blood sugar and in turn HbA1C. Obstetric outcomes like mode of delivery, Amniotic Fluid index, fetal growth were comparable in both groups. Fetal outcomes like birth weight, cord blood insulin, Respiratory distress and hypoglycaemia were also comparable in both groups. Conclusion: Hence, acarbose is a drug with same maternal and neonatal outcomes as insulin but has a better compliance than insulin.

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“…A glibenclamida é considerada a melhor opção entre as sulfonilureias para utilização em gestantes, sendo considerada segura para emprego a partir do segundo trimestre de gestação (10,29,30).…”

Section: Glibenclamidaunclassified

“…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). 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).…”

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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Perinatal outcomes and the use of oral hypoglycemic agents

Cited by 126 publications

References 17 publications

Gestational diabetes: diagnosis and management

Gestational diabetes: diagnosis and management

Comparative Study between Acarbose and Insulin in the Treatment of GDM

Diabetes gestacional: um algoritmo de tratamento multidisciplinar

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