The management of gestational diabetes

Vasc Health Risk Manag. 2009;5(1):153-64. doi: 10.2147/vhrm.s3405. Epub 2009 Apr 8.

Abstract

The incidence of gestational diabetes is increasing. As gestational diabetes is associated with adverse pregnancy outcomes, and has long-term implications for both mother and child, it is important that it is recognized and appropriately managed. This review will examine the pharmacological options for the management of gestational diabetes, as well as the evidence for blood glucose monitoring, dietary and exercise therapy. The medical management of gestational diabetes is still evolving, and recent randomized controlled trials have added considerably to our knowledge in this area. As insulin therapy is effective and safe, it is considered the gold standard of pharmacotherapy for gestational diabetes, against which other treatments have been compared. The current experience is that the 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 short-term 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.

Keywords: gestational diabetes; insulin; oral antidiabetic agents; pregnancy; type 2 diabetes.

Publication types

  • Review

MeSH terms

  • Administration, Oral
  • Blood Glucose / drug effects
  • Blood Glucose Self-Monitoring
  • Diabetes, Gestational / blood
  • Diabetes, Gestational / diet therapy
  • Diabetes, Gestational / drug therapy*
  • Drug Administration Schedule
  • Exercise
  • Female
  • Fetus / drug effects
  • Glyburide / therapeutic use
  • Humans
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / therapeutic use*
  • Injections
  • Insulin / analogs & derivatives
  • Insulin / therapeutic use
  • Metformin / therapeutic use
  • Postpartum Period
  • Pregnancy
  • Pregnancy Outcome
  • Treatment Outcome

Substances

  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin
  • Metformin
  • Glyburide