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Curr Diab Rep. 2019 Dec 6;19(12):158. doi: 10.1007/s11892-019-1243-1.

The Use of Non-insulin Agents in Gestational Diabetes: Clinical Considerations in Tailoring Therapy.

Author information

1
Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA.
2
Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA. npalermo@bwh.harvard.edu.

Abstract

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. 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.

KEYWORDS:

Diabetes mellitus; Gestational diabetes; Hyperglycemia; Impaired glucose tolerance; Perinatal outcomes; Pregnancy

PMID:
31811400
DOI:
10.1007/s11892-019-1243-1

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