The Journal of Clinical Psychiatry has published new evidence that shows that diabetes is best treated during pregnancy, with insulin a first-line treatment and metformin an increasingly accepted alternative.
Diabetes medication and major congenital malformations
The prevalence of type 2 diabetes mellitus (T2DM) is on the rise globally. It’s particularly high among women of reproductive age and those with psychiatric disorders. This trend is concerning as many pregnancies are unplanned, increasing the likelihood of inadvertent exposure to diabetes during pregnancy. Both pregestational and gestational diabetes pose significant risks to maternal and fetal health. This includes complications such as obesity, hypertension, and fetal abnormalities. Psychotropic medications, commonly prescribed for psychiatric disorders, can exacerbate the risk of T2DM due to their side effects.
Recent research has shed light on diabetes management during pregnancy, emphasizing the importance of treatment to mitigate risk. Insulin remains the primary treatment option during pregnancy, but alternatives like metformin are becoming increasingly accepted. Safety data on second-line antidiabetic treatments are promising, with studies indicating no significant increase in congenital malformations compared to insulin. However, these findings are not definitive. The authors say researchers must do more to better understand the safety and efficacy of these treatments.
A recent large retrospective cohort study spanning multiple countries found reassuring results regarding the safety of second-line antidiabetic treatments during pregnancy. The study, which included data from over 50,000 women with pregestational T2DM, showed no significant increase in major congenital malformations or cardiac malformations in offspring exposed to these treatments compared to insulin. Despite these promising findings, the study had limitations. These include potential confounding factors and small sample sizes for certain drug classes, which warrant cautious interpretation.
Overall, effective management of diabetes during pregnancy is crucial to mitigate risks to both mother and child. Prenatal care plays a vital role in monitoring and managing diabetes-related complications, emphasizing the need for informed treatment decisions. While insulin remains the cornerstone of treatment, the emerging evidence supporting the use of alternative medications like metformin provides additional options. But researchers must do more to validate the efficacy of these treatments.
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