New treatment modalities in diabetic pregnancy
Gestational diabetes affect about 5% of all pregnancies and is associated with increased risk for mother and fetus. It has been shown to be associated with increased risk for preeclampsia, postpartal bleeding, and cesarean section rate as well as intrauterine fetal death, macrosomia, shoulder dystocia, and neonatal hypoglycaemia. Several studies have shown the beneficial effect of tight blood glucose control even in mild gestational diabetes. Diet and insulin treatment are the first choice and recommended by the most national committees.
Different oral antidiabetic agents seem to be as effective as insulin to achieve sufficient glycaemic control. They share the advantage of oral administration which might increase the acceptability of this medication by the patients and might be more cost effective than insulin.
Glyburide, a second generation sulfonylurea which does not significantly cross the placenta and metformin, an oral agent in the biguanide class, have shown no teratogenic effects on the fetus and seem to be safe for the use during pregnancy.
Nevertheless oral antidiabetic agents are not generally recommended during pregnancy.
Several issues have to be addressed before the use of these agents as a first line therapy of gestational diabetes. The safety and teratogenic potency have to be clearly documented and the best dosage has to be established to promote maternal well-being and avoid adverse neonatal outcomes.