Antidiabetic Agents: Preconception Considerations

Julie Sease, PharmD, BCPS, CDE, BCACP

Disclosures

November 26, 2014

Question

What medication considerations are important for women with diabetes who are considering pregnancy?

Response from Julie Sease, PharmD, BCPS, CDE, BCACP
Associate Professor, Presbyterian College School of Pharmacy; Clinical Pharmacy Specialist, Good Shepherd Free Medical Clinic, Clinton, South Carolina

Women with type 2 diabetes mellitus (T2DM) must contend with all of the concerns and planning that any mother goes through when considering pregnancy or finding out that she is newly pregnant. In addition, these women must face a number of considerations related to their T2DM. Recommendations from the American Diabetes Association[1,2,3] can assist the clinician with preconception care in women with diabetes. General points follow:

Hemoglobin A1c levels should be as close to normal as possible or less than 7% before conception is attempted.[1]

Because pregnancy can make blood glucose more difficult to control, many women will require transition to basal/prandial insulins in order to maintain adequate blood sugar control, though several oral options do carry a category B rating as well. Pregnancy categories for many available antidiabetic agents are included in the Table .

Many drugs commonly used in T2DM patients are not safe for use during pregnancy:

    - Statins are pregnancy category X and should be discontinued prior to pregnancy. In fact, any medication used to lower cholesterol is generally considered contraindicated during pregnancy.[4]

    - Angiotensin-converting enzyme inhibitors, commonly used for their antihypertensive and renoprotective effects, are pregnancy category X.[1] Angiotensin receptor blockers, used in T2DM for the same indications, are category C in the first trimester but category D in the second and third trimesters. As such, these agents should be discontinued prior to pregnancy and replaced, if needed, with another antihypertensive, such as methyldopa, a commonly used antihypertensive in pregnancy.[1]

Women with T2DM should be evaluated and treated for retinopathy, nephropathy, neuropathy, and cardiovascular disease before pregnancy.[1]

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