Thursday, June 21, 2012


Article by Alanna Ritchie
"Diabetes Medication and Pregnancy

Around 150,000 women are diagnosed with gestational diabetes mellitus (GDM) every year in the United States. More pregnancy complications result from GDM and type 2 diabetes than type 1 diabetes.

GDM occurs when glucose level rise during pregnancy and leads to complications that can include preeclampsia (high blood pressure), Cesarean delivery, shoulder dystocia, stillbirth, neonatal hypoglycemia and fetal macrosomia (big baby syndrome).
For women with GDM, as their pregnancy progresses, their glucose levels increase. Generally, following the birth of the child, the mother's glucose levels return to normal.

Some women with GDM are able to monitor blood sugar and make diet changes, but others require medication. According to the Diabetes Spectrum Journal, women with glucose levels greater than or equal to 120 mg/dl should use either insulin or oral medication.

Some doctors prescribe insulin, which may reduce the likelihood of fetal macrosomia. High infancy weight can mean more occurrences of type 2 diabetes, hypertension and obesity in adulthood.

Thus far, the American Diabetes Associations and the American College of Obstetrics and Gynecology do not endorse any oral agents for GDM. Insulin is the only treatment approved by the Food and Drug Administration (FDA).
However, oral agents are still commonly used.

The most recommended oral medication is glyburide, a sulfonylurea, because the positive outcomes are similar to that of insulin, and most studies show that the medicine cannot cross the placenta, keeping the baby safe.
Metformin, rosiglitazone and pioglitazone all cross the placenta, so they are not recommended.

However, a study from The New England Journal of Medicine found that metformin was not associated with perinatal complications and was preferred over insulin treatment.

Pioglitazone (Actos) should be approached with caution by everyone because of adverse side effects like weakened bones, impaired vision, heart problems and bladder cancer. Many users have filed an Actos lawsuit against the manufacturer of Actos after being diagnosed with bladder cancer.

In 2012, the National Cancer Institute estimates that nearly 15,000 Americans will die from bladder cancer. Actos and bladder cancer symptoms include back pain, blood in urine, pain while urinating and an increased need to urinate.

Eventually, more studies may show alternatives to insulin and the safe use of oral agents for GDM. Until then, oral agents can assist type 2 diabetes patients — which GDM mothers may become, as the diagnosis of GDM increases the likelihood of the mother developing type 2 diabetes during the 20 years following pregnancy."