August 2003 · Vol. 15, No. 8Gestational diabetes and oral hypoglycemic agents: A fresh look at the safety profile
Although insulin has been the treatment of choice when dietary measures fail, oral hypoglycemic drugs are increasingly recognized as safe and effective.
ODED
LANGER,
MDDr. Langer is Babcock Professor and chairman, department of obstetrics and gynecology, St. Luke’s-Roosevelt Hospital Center, University Hospital of Columbia University,
New York, NY.
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KEY POINTS
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Well-designed studies have found no association between oral hypoglycemic agents and congenital malformations. Data suggest that glyburide and possibly metformin are safe and effective for gestational diabetes.
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Reserve medical therapy with oral agents for patients whose fasting plasma glucose levels remain above 95 mg/dL (or postprandial levels above 120 mg/dL) despite diet therapy, and for those who are not appropriate candidates for diet therapy alone.
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Substitute combination or insulin therapy for oral therapy if desired levels of glucose control are not achieved.
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Although use of oral hypoglycemic and antihyperglycemic agents in pregnancy has long been thought to increase the risk of fetal anomalies, 2 trials within the past decade indicate otherwise. In those trials, blood glucose levels—rather than the drugs themselves—were responsible for the greater rate of anomalies.1,2
As a result, oral hypoglycemic agents are gaining recognition as a safe and effective alternative to insulin when diet alone fails to optimize the glycemic profile in gestational diabetes. Sulfonylureas are the only oral agents that have been studied in randomized, controlled trials in women with gestational diabetes,3 but other drugs may have an even greater therapeutic effect. Indeed, use of these other agents for type 2 diabetes has become the standard of care for the nongravid patient.4,5 Only recently has their use in pregnancy become arguable in US scientific forums.
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