The treatment for gestational diabetes always includes special meal plans and scheduled physical activity, and it may also include daily blood glucose testing and insulin injections[1][2][3]. Many women with gestational diabetes can manage their blood glucose levels by following a healthy eating plan and being physically active. However, if lifestyle changes are not enough to control blood sugar levels, medication may be necessary[1][2][3].
Insulin is the traditional first-choice drug for blood sugar control during pregnancy because it is the most effective for fine-tuning blood sugar and it doesn’t cross the placenta to the baby. Insulin therapy is safe for the developing baby, and multiple daily injections are usually required[3].
As an alternative — or in addition — to insulin, your doctor may prescribe an oral medication, such as glyburide or metformin[1][4][5]. Both therapeutic modalities have published safety and efficacy data, but there remains much debate among experts[4]. Glyburide, a second-generation sulfonylurea, has been studied in pregnant women with gestational diabetes and was compared to insulin treatment in a randomized controlled trial, and glucose control was similar. In addition, the glyburide and insulin groups had similar pregnancy outcomes, including cesarean delivery rates, preeclampsia, and macrosomia[5].
Metformin is taken as a tablet up to three times a day, usually with or after meals. Side effects of metformin can include feeling sick, being sick, stomach cramps, diarrhea, and loss of appetite. Occasionally, a different tablet called glibenclamide may be prescribed[6]. However, the safety of taking oral diabetes medications, particularly in the early part of pregnancy when the fetus is still forming (organogenesis), has not yet been determined. Early-generation sulfonylurea drugs crossed the placenta and had the potential to stimulate the fetal pancreas, leading to high levels of insulin in the fetus. This caused concern over the potential harm to the fetus[5].
If you have gestational diabetes, the chances of having problems with the pregnancy can be reduced by controlling your blood sugar (glucose) levels. You’ll also need to be more closely monitored during pregnancy and labor to check if treatment is working and for any problems. Checking your blood sugar level is important, and you’ll be given a testing kit that you can use to check your blood sugar (glucose) level. This involves using a finger-pricking device and putting a drop of blood on a testing strip. You’ll be advised on how to test your blood sugar level correctly, when and how often to test your blood sugar, what level you should be aiming for, and how to share your blood sugar levels with your care team to help you get the right advice and treatment[6].
If you have concerns about gestational diabetes, talk to your healthcare provider about what you can do to reduce your risk and help prevent diabetes in the future.
Citations:
[1] https://www.everydayhealth.com/gestational-diabetes/guide/treatment/
[2] https://diabetes.org/diabetes/gestational-diabetes/how-to-treat-gestational-diabetes
[3] https://diabetes.org/diabetes/gestational-diabetes/prenatal-care
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4865390/
[5] https://www.evms.edu/patient_care/specialties/maternal_fetal_medicine/services/diabetes_in_pregnancy_program/medications_for_diabetes/
[6] https://www.nhs.uk/conditions/gestational-diabetes/treatment/
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