Relief for women who accidentally fall pregnant while on diabetes meds

2 minute read

Early research suggests that non-insulin antidiabetic drugs are safe for pregnant women.

Women who take second-line noninsulin antidiabetic medication during pregnancy are not more likely to have babies with congenital anomalies, research suggests.

While it is known that infants whose mothers have pre-gestational type 2 diabetes have a higher prevalence of major congenital malformations – including cardiac malformations – compared with infants in the general population, there is little evidence as to the safety of non-insulin diabetic medication with current recommendations cautioning against the use of these medications in pregnancy, the researchers found.

But this latest observational study, including more than 15,000 women with type 2 diabetes who took non-insulin antidiabetic medication at some point in the three months before and after conception, found there was no increased risk of birth defects associated with the treatment.

“In infants born to women with type 2 diabetes treated with second-line antidiabetic medications, we did not observe a greater risk of major congenital malformations after periconceptional exposure to sulfonylureas, DPP-4 inhibitors, GLP-1 receptor agonists, or SGLT2 inhibitors compared with insulin,” they wrote in JAMA Internal Medicine.

The researchers said 50% of the women took metformin only, 34% used insulin, 9.0% took a sulfonylurea, 4.5% took a DPP-4 inhibitor, 6.2% took a GLP-1 receptor agonist, and 2.2% took an SGLT2 inhibitor.

“Although reassuring, confirmation from other studies is needed, and continuous monitoring will provide more precise risk estimates in the future as data accumulate.”

The researchers said the numbers of infants exposed to GLP-1s prenatally was expected to increase along with the rising popularity of that class of drugs for weight loss.

“Although this study did not suggest that these medications have strong teratogenic effects, there is a need for further research to fully evaluate the safety of these medications in pregnancy,” they said.

A spokesperson from the Royal Hospital for Women said GLP-1 receptor agonists were classified as Category D according to the TGA’s Australian categorisation system for prescribing medicines in pregnancy.

“The current advice for women taking GLP-1 receptor agonists and other antidiabetic medications during pregnancy is to see the medical practitioner that provides their diabetic care prior to conceiving (or as soon as women find out they are pregnant) to optimise their care,” the spokesperson said.

“This should include advice around stopping GLP-1 receptor agonists and other antidiabetic medications at least one month prior to conception and/or commencing medications such as insulin that is recognised for treating diabetes in pregnancy.”

JAMA Internal Medicine 2023, online 11 December

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