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The use of oral hypoglycaemic agents in pregnancy

The use of oral hypoglycaemic agents in pregnancy
The use of oral hypoglycaemic agents in pregnancy
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.
0742-3071
282-291
Holt, R.I.G.
d54202e1-fcf6-4a17-a320-9f32d7024393
Lambert, K.D.
d62310b6-f91f-4de5-ba89-a01d9030a226
Holt, R.I.G.
d54202e1-fcf6-4a17-a320-9f32d7024393
Lambert, K.D.
d62310b6-f91f-4de5-ba89-a01d9030a226

Holt, R.I.G. and Lambert, K.D. (2014) The use of oral hypoglycaemic agents in pregnancy. Diabetic Medicine, 31 (3), 282-291. (doi:10.1111/dme.12376). (PMID:24528229)

Record type: Article

Abstract

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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More information

Accepted/In Press date: 29 November 2013
e-pub ahead of print date: 16 February 2014
Published date: 31 March 2014
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 394652
URI: http://eprints.soton.ac.uk/id/eprint/394652
ISSN: 0742-3071
PURE UUID: 14022d10-a3a0-42b7-8ae5-99a86eed74ef
ORCID for R.I.G. Holt: ORCID iD orcid.org/0000-0001-8911-6744

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Date deposited: 23 May 2016 09:17
Last modified: 18 Feb 2021 16:56

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Author: R.I.G. Holt ORCID iD
Author: K.D. Lambert

University divisions

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