Treatment of diabetes before and during pregnancy

Anita McGrogan, Julia Snowball, Corinne De Vries

Research output: Contribution to journalArticle

Abstract

Background: Diabetes in pregnancy is associated with an increased risk of congenital malformations and perinatal mortality and it is important to maintain good maternal glycaemic control. Treatment with insulin is preferred although some patients are treated with metformin; use of other oral products however is contraindicated in pregnancy due to the risk of teratogenicity.

Objectives: To investigate the utilisation of insulin and oral antidiabetic medicines (ADM) during pregnancy and in the 12 months before pregnancy.

Methods: All women with a diabetes diagnosis before or during pregnancy were identified on the UK General Practice Research Database. The study period was from January 1992 until March 2007. Prescription records for ADM in the year before and/or during pregnancy were identified for these women. Type of diabetes was determined using an algorithm identifying medical diagnoses, age at first diagnosis and prescribing records. ADM utilisation was evaluated by diabetes type.

Results: 21,072 diabetes‐affected pregnancies were identified. Of these, 18,373 (87.2%) were gestational diabetes (GDM), 1979 (9.4%) type 1 (DM1) and 720 (3.4%) type 2 (DM2). GDM management was with diet alone in 17,480 (95.1%) of cases. All DM1 patients were prescribed insulin. Whilst the majority (211, 65%) of DM2 patients switched from oral ADM to insulin, amongst those with GDM or DM2 who did not have a pregnancy loss, 228 (17.4% of those eligible) were prescribed oral ADM during pregnancy. Of the oral ADM, 15% constituted products other than metformin.

Conclusions: In general these findings are in line with treatment guidelines. However, some women were prescribed oral ADM during pregnancy. Further work is needed to evaluate trends in management and associated pregnancy outcomes of GDM.
Original languageEnglish
Article number156
Pages (from-to)S66
JournalPharmacoepidemiology and Drug Safety
Volume19
Issue numberS1
DOIs
Publication statusPublished - 2010
Event26th International Conference on Pharmacoepidemiology & Therapeutic Risk Management - Brighton, UK United Kingdom
Duration: 19 Aug 201022 Aug 2010

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