Pharmaceutical Care in Gestational Diabetes MellitusM. Amin, N. Suksomboon*
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Gestational diabetes mellitus (GDM) is defined as diabetes diagnosed during pregnancy that is not clearly overt. Mild glucose intolerance during pregnancy has been linked to adverse pregnancy outcomes which affects both mother and fetus. As controversy continues concerning optimal strategy for diagnosing GDM, there also has been much confusion surrounding its management. It remains controversial whether treatment of GDM is effective and if treatment helps reduce the incidence of adverse pregnancy outcomes. Current evidence supports medical nutrition therapy (MNT) along with exercise and self-monitoring of blood glucose as cornerstone of GDM management. Although human insulin is the standard treatment for patients who cannot achieve desired glycemic levels with MNT and exercise, small scale studies with insulin analogues, lispro and aspart are also encouraging. In addition, glibenclamide and metformin have also displayed comparable efficacy to human insulin. Glibenclamide does not cross human placenta, therefore, it may be a safer alternative as compared to metformin which crosses human placenta but it is not teratogenic. However, higher incidence of preterm births have been reported in metformin-treated pregnant women, but this needs further confirmation. Present evidence greatly supports oral anti-diabetic therapy with glibenclamide and metformin besides insulin lispro and insulin aspart as alternatives to regular human insulin if MNT and exercise fails to achieve desired glycemic targets.
Keyword:
Gestational diabetes, pregnancy, macrosomia, insulin, glibenclamide, metformin.
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