Effect of Oral Hypoglycemic Drugs on the Outcome of Pregnancy in Type 2 Diabetes Mellitus

Background: Type 2 diabetes mellitus (T2DM) is a progressive and complex disorder that is difficult to treat effectively in the long term. The majority of patients are overweight or obese at diagnosis and will be unable to achieve or sustain near normoglycemia without oral antidiabetic agents; a sizeable proportion of patients will eventually require insulin therapy to maintain long-term glycemic control, either as monotherapy or in conjunction with oral antidiabetic therapy. The frequent need for escalating therapy is held to reflect progressive loss of islet β-cell function, usually in the presence of obesity-related insulin resistance. Today’s clinicians are presented with an extensive range of oral antidiabetic drugs for T2DM. Objective: This article will discuss the various effects of oral hypoglycemic drugs on the outcome of pregnancy with T2DM. Material And Methods: Patients were attending the combined outpatient clinic for Internal Medicine Department, Endocrinology Unit and Obstetrics Department of Zagazig University Hospital, were entered into a database. The following maternal, fetal and neonatal items were retrieved from the database. Maternal outcome (pre-eclampsia, pre-term delivery, Cesarean section) and fetal and neonatal outcome (macrosomia, congenital malformations, perinatal mortality, neonatal hypoglycemia) were analyzed as well HbA1c levels, planning of pregnancy, gestational age at first antenatal visit. One hundred-fifty pregnant female were classified into three groups. All pregnant females were subjected to full medical history with thorough medical examination, routine laboratory investigations include (fasting blood glucose [FBG] level, 2-hours post prandial glucose level [2-hpp]), glycosylated hemoglobin (HbA1c) and pelvi-abdominal ultrasonography. Results: In the present study, 50 pregnancies in T2DM have delivery and they incidentally continued the use of their oral anti-diabetes (OADs) (e.g., sulphonylurea and biguanides) before realizing that they had got pregnant for a period from 1-4 weeks. As regards, the relation between fetal macrosomia and types of OADs; there were nonsignificant statistically value occurred in all studied groups used biguanides. The relation between neonatal hypoglycemia and types of OADs; there is nonsignificant value in the OADs group of the studied groups. Also, there is nonsignificant value between OADs types and neonatal polycythemia, hyperbilirubinemia and respiratory distress. There were nonsignificant value in the cases of studied groups with birth injury and types of OADs, but it did not occur with biguanide use. There was nonsignificant statistical value between intra uterine foetal death and types of OADs. There were significant statistical value between CS and types of OADs use in the studied groups. Also, there is nonsignificant statistical value in the incidence of abortion and types of OADs (weeks). It occurred mostly with sulphonylurea, and did not occur with biguanide use. As regards, the results obtained the relation between incidence of preeclampsia and types of OADs, there was nonsignificant statistical value, it occurred mostly with sulphonylurea and did not occur with biguanide in cases of the studied groups. There was relation between polyhydramnios and the types of OADs. There were nonsignificant statistical value occurred only with the use of sulphonylurea in cases of the studied groups. Conclusion: The use of oral hypoglycemic drugs on the outcome of pregnancy in type 2 diabetes during early pregnancy increases the incidence of maternal complication. Recommendations: 1) Preconception counseling and assessment of glycemic control before conception and during early gestation (first 6 to 8 weeks) is the primary determinant of the risk for various congenital anomalies and early pregnancy loss. 2) Pre pregnancy management should be initiated 3to 6 months before intended conception; the goal is to obtain A1c level within normal range. 3) Oral hypoglycemic drugs must not be taken during early pregnancy. 4) Insulin should be used during pregnancy. [Mohamed S. S. Saad, Hatem M. Salem and Khaled M. Hadhoud. Effect of Oral Hypoglycemic Drugs on the Outcome of Pregnancy in Type 2 Diabetes Mellitus. Journal of American Science 2012; 8(4):95-106]. (ISSN: 15451003). http://www.americanscience.org. 13