The use of anti-hyperglycaemic and hypoglycaemic agents in pregnancy

Based on existing data, glyburide and possibly metformin are safe and effective oral agents that can be used to manage women with gestational diabetes. Well-designed studies report no association between oral hypoglycaemic and anti-hyperglycaemic agents and congenital anomalies. Medical therapy with oral agents should be reserved for patients who have failed diet therapy (i.e., those who have fasting plasma glucose levels exceeding 5.3 mmol/L (95 mg/dL) or postprandial levels above 6.6 mmol/L (120 mg/dL). Insulin therapy should be reserved for cases that fail to achieve the targeted levels of glycaemic control with oral agents, or those with specific medical indications. Moreover, for optimal results with oral agents, women must adhere to a diabetic diet and maintain the targeted level of glycaemic control.