Abstract
The incidence of gestational diabetes mellitus (GDM) is still rising, and this pathological condition is strongly associated with some serious adverse pregnancy outcomes. Therefore, GDM must be timely recognized and adequately managed. Treatment of GDM is aimed to maintain normal glycemia and it should involve regular glucose monitoring, dietary modification, lifestyle changes, moderate physical activity, and pharmacotherapy, when necessary. As for the pharmacotherapy, needed in approximately one-third of GDM women, insulin administration is the first choice of pharmacological treatment, although oral hypoglycemic drugs, for example, metformin (a biguanide agent) or glyburide (a second-generation sulfonylurea drug), could be indicated, too. Metformin is considered as a reasonable and safe first-line alternative to insulin. If comparing two oral agents, metformin seems to be safer than glyburide, since glyburide was found to be linked to neonatal hypoglycemia and higher birth weight, which can for example increase the hazard for shoulder dystocia and a necessity for Cesarean delivery. Finally, it should be underlined that many pregnant women turn to complementary and alternative medicine for health maintenance or symptom relief, including traditional herbal medicine and the use of supplements. Given the previous facts, this chapter will address current pharmacotherapy options and challenges related to GDM treatment.
Highlights
Gestational diabetes mellitus (GDM) is well-described endocrinopathy, referring to any degree of glucose intolerance that develops or else is initially recognized during pregnancy
In accordance with previous facts, up-to-date results of available meta-analyses on the effects of antidiabetic pharmaceuticals estimated that if we look to the majority of adverse neonatal outcomes, metformin was ranked to be the superior treatment over insulin or glyburide, whereas the lower risk of adverse maternal outcomes was primarily linked to glyburide administration [14]
We look at how insulin and other oral hypoglycemic medications are used to treat women with GDM, emphasizing on their efficacy and safety
Summary
Gestational diabetes mellitus (GDM) is well-described endocrinopathy, referring to any degree of glucose intolerance that develops or else is initially recognized during pregnancy. In accordance with previous facts, up-to-date results of available meta-analyses on the effects of antidiabetic pharmaceuticals estimated that if we look to the majority of adverse neonatal outcomes, metformin was ranked to be the superior treatment over insulin or glyburide, whereas the lower risk of adverse maternal outcomes was primarily linked to glyburide administration [14]. These divergent effects require additional caution in their use [8]. Supplement-related and other alternative pharmacotherapy will be addressed, as well
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