Published in:
01-12-2019 | Neonatal Hypoglycemia | Therapies and New Technologies in the Treatment of Diabetes (M Pietropaolo, Section Editor)
The Use of Non-insulin Agents in Gestational Diabetes: Clinical Considerations in Tailoring Therapy
Published in: Current Diabetes Reports | Issue 12/2019
Login to get accessAbstract
Purpose of Review
To assess evidence to date for use of non-insulin agents in treatment of gestational diabetes mellitus.
Recent Findings
There has been increasing interest in the use of non-insulin agents, primarily metformin and glyburide (which both cross the placenta). Metformin has been associated with less maternal weight gain; however, recent studies have shown a trend toward increased weight in offspring exposed to metformin in utero. Glyburide has been associated with increased neonatal hypoglycemia.
Summary
Glycemic control during pregnancy is essential to optimize both maternal and fetal outcomes. There are a myriad of factors to consider when designing treatment programs including patient preference, phenotype, and glucose patterns. While insulin is typically recommended as first-line, some women refuse or cannot afford insulin and in those cases, non-insulin agents may be used. Further studies are needed to assess treatment in pregnancy, perinatal outcomes, and particularly long-term metabolic profiles in mothers and offspring.