Oral Antidiabetic Agents in Gestational Diabetes Mellitus- Shifting of Paradigm?

Abstract

Diabetes mellitus is one of the most common medical complications of pregnancy; gestational diabetes mellitus (GDM) accounts for approximately 90-95% of all cases. The incidence of gestational diabetes is increasing. It has been demonstrated that good metabolic control maintained throughout pregnancy can reduce maternal and fetal complications in diabetes Traditionally, insulin therapy has been considered the gold standard for management There has been a traditional reluctance to recommend oral antidiabetic drugs for the management of hyperglycaemia in gestational diabetes mellitus. The medical management of gestational diabetes is still evolving, and recent randomized controlled trials have given a glimse of hope for woman who likes to avoid insulin and prefer oral agents. The current short acting insulin analogs lispro and aspart are safe, but there are only limited data to support the use of long acting insulin analogs. There are randomized controlled trials which have demonstrated efficacy of the oral agents glyburide and metformin. Whilst shortterm data have not demonstrated adverse effects of glyburide and metformin on the fetus, and they are increasingly being used in pregnancy, there remain long-term concerns regarding their potential for harm. This controversy related article gives an overview of the rationale for use of oral antidiabetic agents in the treatment of gestational diabetes. DOI: 10.3329/jdmc.v17i2.6596J Dhaka Med Coll. 2008; 17(2) : 127-130