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Treating diabetes in pregnancy

Pre-existing diabetes in this age group will, in most cases, be controlled with insulin. The woman will almost always be on this already. In the unlikely event that she has used dietary control, conception will almost certainly mean a switch to insulin.

Insulin is not only safe; it is actually beneficial in preventing birth defects. Those diabetic mothers whose diabetes had been well controlled before conception reduce the risk of congenital malformation quite significantly. In poorly controlled diabetics, the risk of major malformations in their children is up to three times that of the general population.

Oral hypoglycemics in pregnancy

In non-pregnant individuals, there is a place for what are known as "oral hypoglycemics". These have an effect of lowering blood-sugar levels, to various degrees. Most of them (Chlorpropamide, Glibenclamide, Gliquidone, Glipizide and Tolbutamide) cross the placenta and are likely to cause a catastrophic fall in fetal blood-sugar. They are not used in pregnancy.

Metformin (Glucophage®) is one oral hypoglycemic that is known to cross the placenta. Extensive studies have shown that Metformin use in pregnancy is safe and as a result it is increasingly deployed, either on its own or, more often, as an adjunct to insulin. Its use appears to have helped attain good glycemic (blood sugar) control for some women who are otherwise challenging especially during pregnancy.

Treating diabetes in pregnancy

Oral hypoglycemics in pregnancy

Diabetes in pregnancy is discussed in much more detail here: