PDF
ePub
Citation
Print
Abstract
Pregnant women with diabetes are at greater risk for adverse outcomes, such as miscarriage, macrosomia, and preterm birth. Advances in the care of diabetes have reduced maternal and perinatal mortality rates to the levels expected in nondiabetic pregnancies. Lifestyle modification such as medical nutritional therapy and exercise is a first step in therapy for gestational diabetes. Rapid-acting insulin analogs (lispro, aspart) are comparable in safety and superior in glucose control to regular human insulin. Because the safety of long-acting insulin analogs (glargine, detemir) in pregnancy has not firmly established, the use of human insulin is preferred over basal insulin. Among the oral hypoglycemic agents, metformin and glyburide might be considered as alternative therapies.
REFERENCES
1. Metzger BE. Summary and recommendations of the Third International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes. 1991; 40:197–201.
2. International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva A, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJ, Omori Y, Schmidt MI. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010; 33:676–82.
3. Basevi V, Di Mario S, Morciano C, Nonino F, Magrini N. Comment on: American Diabetes Association. Standards of medical care in diabetes–2011. Diabetes Care. 2011; 34(Suppl. 1):S11–61.
4. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, Wapner RJ, Varner MW, Rouse DJ, Thorp JM Jr, Sciscione A, Catalano P, Harper M, Saade G, Lain KY, Sorokin Y, Peaceman AM, Tolosa JE, Anderson GB. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009; 361:1339–48.
5. Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR, Hod M, Kitzmiller JL, Kjos SL, Oats JN, Pettitt DJ, Sacks DA, Zoupas C. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care. 2007; 30:S251–60.
6. Kitzmiller JL, Block JM, Brown FM, Catalano PM, Conway DL, Coustan DR, Gunderson EP, Herman WH, Hoffman LD, Inturrisi M, Jovanovic LB, Kjos SI, Knopp RH, Montoro MN, Ogata ES, Paramsothy P, Reader DM, Rosenn BM, Thomas AM, Kirkman MS. Managing preexisting diabetes for pregnancy: summary of evidence and consensus recommendations for care. Diabetes Care. 2008; 31:1060–79.
7. Kjos SL, Schaefer-Graf U, Sardesi S, Peters RK, Buley A, Xiang AH, Bryne JD, Sutherland C, Montoro MN, Buchanan TA. A randomized controlled trial using glycemic plus fetal ultrasound parameters versus glycemic parameters to determine insulin therapy in gestational diabetes with fasting hyperglycemia. Diabetes Care. 2001; 24:1904–10.
8. Norman RJ, Wang JX, Hague W. Should we continue or stop insulin sensitizing drugs during pregnancy? Curr Opin Obstet Gynecol. 2004; 16:245–50.
9. Menon RK, Cohen RM, Sperling MA, Cutfield WS, Mimouni F, Khoury JC. Transplacental passage of insulin in pregnant women with insulin-dependent diabetes mellitus. Its role in fetal macrosomia. N Engl J Med. 1990; 323:309–15.
10. Jovanovic-Peterson L, Kitzmiller JL, Peterson CM. Randomized trial of human versus animal species insulin in diabetic pregnant women: improved glycemic control, not fewer antibodies to insulin, influences birth weight. Am J Obstet Gynecol. 1992; 167:1325–30.
11. Jovanovic L, Ilic S, Pettitt DJ, Hugo K, Gutierrez M, Bowsher RR, Bastyr EJ 3rd. Metabolic and immunologic effects of insulin lispro in gestational diabetes. Diabetes Care. 1999; 22:1422–7.
12. Hod M, Damm P, Kaaja R, Visser GH, Dunne F, Demidova I, Hansen AS, Mersebach H. Insulin Aspart Pregnancy Study Group. Fetal and perinatal outcomes in type 1 diabetes pregnancy: a randomized study comparing insulin aspart with human insulin in 322 subjects. Am J Obstet Gynecol. 2008; 198:186. e1-7.
13. Pollex EK, Feig DS, Lubetsky A, Yip PM, Koren G. Insulin glargine safety in pregnancy: a transplacental transfer study. Diabetes Care. 2010; 33:29–33.
14. Graves DE, White JC, Kirk JK. The use of insulin glargine with gestational diabetes mellitus. Diabetes Care. 2006; 29:471–2.
15. Price N, Bartlett C, Gillmer M. Use of insulin glargine during pregnancy: a case-control pilot study. BJOG. 2007; 114:453–7.
16. Pantalone KM, Faiman C, Olansky L. Insulin glargine use during pregnancy. Endocr Pract. 2011; 17:448–55.
17. Druckmann R, Rohr UD. IGF-1 in gynaecology and obstetrics: update 2002. Maturitas. 2002; 41:S65–83.
18. Kovo M, Haroutiunian S, Feldman N, Hoffman A, Glezerman M. Determination of metformin transfer across the human placenta using a dually perfused ex vivo placental cotyledon model. Eur J Obstet Gynecol Reprod Biol. 2008; 136:29–33.
19. Rowan JA, Hague WM, Gao W, Battin MR, Moore MP. MiG Trial Investigators. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med. 2008; 358:2003–15.
20. Coetzee EJ, Jackson WP. Oral hypoglycaemics in the first trimester and fetal outcome. S Afr Med J. 1984; 65:635–7.
21. Glueck CJ, Wang P, Kobayashi S, Phillips H, Sieve-Smith L. Metformin therapy throughout pregnancy reduces the development of gestational diabetes in women with polycystic ovary syndrome. Fertil Steril. 2002; 77:520–5.
22. Brock B, Smidt K, Ovesen P, Schmitz O, Rungby J. Is metformin therapy for polycystic ovary syndrome safe during pregnancy? Basic Clin Pharmacol Toxicol. 2005; 96:410–2.
23. Glueck CJ, Goldenberg N, Pranikoff J, Loftspring M, Sieve L, Wang P. Height, weight, and motor-social development during the first 18 months of life in 126 infants born to 109 mothers with polycystic ovary syndrome who conceived on and continued metformin through pregnancy. Hum Reprod. 2004; 19:1323–30.
24. Bolen S, Feldman L, Vassy J, Wilson L, Yeh HC, Marinopoulos S, Wiley C, Selvin E, Wilson R, Bass EB, Brancati FL. Systematic review: comparative effectiveness and safety of oral medications for type 2 diabetes mellitus. Ann Intern Med. 2007; 147:386–99.
25. S Briggs GG, Ambrose PJ, Nageotte MP, Padilla G, Wan S. Excretion of metformin into breast milk and the effect on nursing infants. Obstet Gynecol. 2005; 105:1437–41.
26. Langer O, Conway DL, Berkus MD, Xenakis EM, Gonzales O. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med. 2000; 343:1134–8.
27. Sivan E, Feldman B, Dolitzki M, Nevo N, Dekel N, Karasik A. Glyburide crosses the placenta in vivo in pregnant rats. Diabetologia. 1995; 38:753–6.
28. Elliott BD, Langer O, Schenker S, Johnson RF. Insignificant transfer of glyburide occurs across the human placenta. Am J Obstet Gynecol. 1991; 165:807–12.
29. Koren G. Glyburide and fetal safety; transplacental pharmacokinetic considerations. Reprod Toxicol. 2001; 15:227–9.
30. Conway DL, Gonzales O, Skiver D. Use of glyburide for the treatment of gestational diabetes: the San Antonio experience. J Matern Fetal Neonatal Med. 2004; 15:51–5.
31. Anjalakshi C, Balaji V, Balaji MS, Seshiah V. A prospective study comparing insulin and glibenclamide in gestational diabetes mellitus in Asian Indian women. Diabetes Res Clin Pract. 2007; 76:474–5.
32. Merlob P, Levitt O, Stahl B. Oral antihyperglycemic agents during pregnancy and lactation: a review. Paediatr Drugs. 2002; 4:755–60.
33. Feig DS, Briggs GG, Kraemer JM, Ambrose PJ, Moskovitz DN, Nageotte M, Donat DJ, Padilla G, Wan S, Klein J, Koren G. Transfer of glyburide and glipizide into breast milk. Diabetes Care. 2005; 28:1851–5.
34. Glatstein MM, Djokanovic N, Garcia-Bournissen F, Finkelstein Y, Koren G. Use of hypoglycemic drugs during lactation. Can Fam Physician. 2009; 55:371–3.
35. Garcia-Bournissen F, Feig DS, Koren G. Maternal-fetal transport of hypoglycaemic drugs. Clin Pharmacokinet. 2003; 42:303–13.
36. Nicholson W, Baptiste-Roberts K. Oral hypoglycaemic agents during pregnancy: The evidence for effectiveness and safety. Best Pract Res Clin Obstet Gynaecol. 2011; 25:51–63.
XML Download