Oral Antidiabetic Drugs in Pregnancy: The Other Alternative

In the United States, depending on the diagnosis criteria used, 135,000– 200,000 women annually develop gestational diabetes mellitus (GDM), adding to the number of pregnant women who already have either type 1 or type 2 diabetes. There has also been a significant increase (~ 33%) in the incidence of type 2 diabetes with its presumed parallel risk for obesity in addition to the development of adolescent obesity in the offspring of diabetic women. Two main factors have contributed to the dramatic increase in pharmacological therapy: recognition that GDM is an early stage in the development of type 2 diabetes and increased awareness of the impact of the metabolic syndrome on public health and its appearance in 20–50% of women who have had GDM. This article outlines the management approach (intensified treatment) and describes the use of oral antidiabetic agents (mainly glyburide) to prevent glycemic extremes (i.e., hypoglycemia and hyperglycemia) in pregnant women with GDM and type 2 diabetes.