Gestational diabetes Should you use oral agents?

Key Points

Gestational diabetes mellitus (GDM) is glucose intolerance with onset or first recognition during pregnancy. African American, Hispanic, and Native American women have a higher incidence of GDM, although studies indicate that socioeconomic status may be more strongly associated with GDM than race or ethnicity.^1,2

The gold standard of treatment for diabetes in pregnancy, whether preexisting or gestational, has been insulin for patients unable to achieve euglycemia with diet and exercise alone. The controversy surrounding the use of oral agents in pregnancy primarily is related to concerns about unknown effects on the developing fetus, but concerns also exist about the efficacy of these agents during pregnancy, especially in light of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, which demonstrated that even small amounts of maternal hyperglycemia are associated with adverse effects on the fetus.⁷