Use of Oral Hyperglycemic Agents in Pregnancy Diabetes

The underlying principle for the use of oral hypoglycemic agents (OHAs) in pregnancy is motivated by the following factors: Gestational Diabetes Mellitus (GDM) and Impaired Glucose Tolerance (IGT) are characterized by mild hyperglycemia due to insulin resistance. It is reasonable to assume that the treatment of GDM with OHAs would also be effective as in IGT. The use of OHAs has traditionally been contraindicated. This recommendation stems from the potential adverse effect on the developing fetus with the assumption that significant transfer occurs across the placenta. Three issues of concern include: 1. Increased rate of congenital anamolies 2. The possible induction of fetal macrosomia due to direct stimulation of the fetal pancreases resulting in hyperinsulinemia 3. The increased rate of hypoglycemia due to fetal hyperinsulinemia.