Abstract
The prevalence of diabetes during pregnancy and the need for the treatment are increasing. We aimed to investigate antidiabetic medications (ADM) use among pregnant women and their characteristics. Using Korea’s nationwide healthcare database, we included women aged 15–49 years with births during 2004–2013. The prevalence and secular trend of ADM use were assessed in 3 periods: pre-conception period, first trimester, and second/third trimesters. To compare maternal characteristics between pregnancies with and without ADM prescription, we used the χ2 or Fisher’s exact test and Cochran-Armitage trend test. The prescription patterns analyzed by calendar year, age, insurance type, income, area, and medical institution. Of 81,559 pregnancies, 222 (0.27%) and 305 (0.37%) were exposed ADM during pre-conception and pregnancy periods, respectively. ADM prescriptions increased significantly by an 11.3-fold in second/third trimesters, while a 2.9-fold in first trimester. ADM use is more prevalent in women aged older and living in urban areas. Metformin was most used in the pre-conception period, while insulins were most during pregnancy. About 0.4% of women received ADM during pregnancy; a rate was lower than that in western countries. Non-recommended medications were more common in first trimester, which warrants pregnancy screening for women taking ADM.
Highlights
The prevalence of diabetes during pregnancy and the need for the treatment are increasing
Insulin is recommended as the first-line treatment and metformin may be an alternative if insulin is unable to be used, according to several associations, including the American Diabetes Association (ADA)[12], the American College of Obstetricians and Gynecologists (ACOG)[13], the Canadian Diabetes Association (CDA)[14], and the Korean Diabetes Association (KDA)[11]
Among the aforementioned antidiabetic medications, our analysis focused on the three most commonly utilized drug classes and the remaining drug classes were categorized as other oral agents
Summary
The prevalence of diabetes during pregnancy and the need for the treatment are increasing. We aimed to investigate antidiabetic medications (ADM) use among pregnant women and their characteristics. ADM use is more prevalent in women aged older and living in urban areas. Non-recommended medications were more common in first trimester, which warrants pregnancy screening for women taking ADM. Medication use during pregnancy has grown progressively over past d ecades[3], pregnant women remain therapeutic orphans, as they are generally excluded from clinical trials due to ethical concerns and potential fetal r isk[4,5]. Despite the recommendations of metformin and glyburide for the treatment of GDM, both were known to cross the placenta and their long-term safety is still unknown. Given the uncertain safety evidence, South Korea’s health regulatory agency suggests all types of oral antidiabetic agents should be used with c aution[21]
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