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. 2010 Oct 6:(10):CD007724.
doi: 10.1002/14651858.CD007724.pub2.

Oral anti-diabetic agents for women with pre-existing diabetes mellitus/impaired glucose tolerance or previous gestational diabetes mellitus

Joanna Tieu  1 , Suzette Coat, William Hague, Philippa Middleton
Affiliations

Oral anti-diabetic agents for women with pre-existing diabetes mellitus/impaired glucose tolerance or previous gestational diabetes mellitus

Joanna Tieu et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: While most guidelines recommend the use of insulin in women whose pregnancies are affected by pre-existing diabetes, oral agents have obvious benefits for patient acceptability and adherence. It is necessary, however, to assess the effects of these anti-diabetic agents on maternal and infant health outcomes. Additionally, women with previous gestational diabetes mellitus are increasingly found to be predisposed to impaired glucose tolerance and, despite the potential need for intervention for these women, there has been little evidence about the use of oral anti-diabetic agents by these women pre-conceptionally or during a subsequent pregnancy.

Objectives: To investigate the effect of oral anti-diabetic agents in women with pre-existing diabetes mellitus, impaired glucose tolerance or previous gestational diabetes planning a pregnancy or pregnant women with diabetes mellitus on maternal and infant health.The use of oral antidiabetic agents for management of gestational diabetes in a current pregnancy is evaluated in a separate Cochrane review.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2010).

Selection criteria: We included randomised and quasi-randomised trials.

Data collection and analysis: Two review authors independently assessed trial eligibility for inclusion.

Main results: We identified 13 trials published as 25 papers using the Cochrane Pregnancy and Childbirth group literature search, and an additional ongoing trial. We have not included any trials in the review. One trial is awaiting assessment and we have excluded twelve trials because they evaluated treatment of women with gestational diabetes or women with polycystic ovary syndrome, were not randomised controlled trials or data were not available.

Authors' conclusions: Little randomised evidence is available evaluating the use of oral anti-diabetic agents in women with diabetes mellitus, impaired glucose tolerance, previous gestational diabetes mellitus planning a pregnancy or pregnant women with pre-existing diabetes mellitus. Large trials comparing any combination of oral anti-diabetic agent, insulin and dietary and lifestyle advice in these women, reporting on maternal and infant health outcomes, glycaemic control, women's views on the intervention and long-term health outcomes for mother and child, are required to guide clinical practice.

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References

References to studies excluded from this review

    1. Anjalakshi C, Balaji V, Balaji MS, Seshiah V. A prospective study comparing insulin and glibenclamide in gestational diabetes mellitus in Asian Indian women. Diabetes Research and Clinical Practice. 2007;76(3):474–5. - PubMed
    1. Bertini AM, Silva JC, Taborda W, Becker F, Bebber FR, Viesi JM, et al. Perinatal outcomes and the use of oral hypoglycemic agents. Journal of Perinatal Medicine. 2005;33(6):519–23. - PubMed
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    1. Golladay EC. [accessed 21 March 2006];Glyburide compared to insulin in the management of White’s classification A2 gestational diabetes. ClinicalTrials.gov http://clinicaltrials.gov/
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References to studies awaiting assessment

    1. Hutchinson A, Haugabrook C, Long L, Mason L, Kipikasa J, Adair D. A comparison of glyburide/metformin and insulin for gestational diabetes. American Journal of Obstetrics and Gynecology. 2008;199(6 Suppl 1):S200.
    1. Kipikasa JH. [accessed 20 February 2008];Comparison of glucovance to insulin for diabetes during pregnancy. ClinicalTrials.gov http://clinicaltrials.gov/

References to ongoing studies

    1. Hague WM. [accessed 31 August 2010];Metformin in the prevention of gestational diabetes: the MPG trial. http://www.anzctr.org.au/trial_view.aspx?ID=320961 ACTRN12610000157077.

Additional references

    1. American Diabetes Association Preconception care of women with diabetes. Diabetes Care. 2004;27(Suppl1):S76–S78. - PubMed
    1. McElduff A, Cheung NW, McIntyre HD, Lagstrom JA, Oats JJN, Ross GP, et al. The Australasian Diabetes in Pregnancy Society consensus guidelines for the management of type 1 and type 2 diabetes in relation to pregnancy. Medical Journal of Australia. 2005;183(7):373–7. - PubMed
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    1. Bell R, Bailey K, Cresswell T, Hawthorne G, Critchley J, Lewis-Barned N, et al. Trends in prevalence and outcomes of pregnancy in women with pre-existing type I and type II diabetes. BJOG: an international journal of obstetrics and gynaecology. 2008;115(4):445–52. - PubMed
    1. Brock B, Smidt K, Ovesen P, Schmitz O, Rungby J. Is metformin therapy for polycystic ovary syndrome safe during pregnancy? Basic & Clinical Pharmacology & Toxicology. 2005;96:410–12. - PubMed

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