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Clinical Review State of the Art Review

Novel therapies for diabetes mellitus in pregnancy

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k2034 (Published 16 July 2018) Cite this as: BMJ 2018;362:k2034
  1. Maisa N Feghali, assistant professor1,
  2. Christina M Scifres, associate professor2
  1. 1Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
  2. 2Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA
  1. Correspondence to: M Feghali maisafeghali{at}gmail.com

ABSTRACT

Diabetes is a common complication of pregnancy, and the prevalence of all types of the disease is increasing worldwide. Diabetes in pregnancy is associated with short term and long term adverse effects for mother and child. The goal of treatment of diabetes in pregnancy is to minimize maternal and fetal adverse events related to hyperglycemia. Treatment options vary by type of diabetes, from a focus on lifestyle modifications in gestational diabetes to continuous glucose monitoring and insulin pumps in pregestational diabetes. Nevertheless, given the commonality of hyperglycemia, considerable overlap exists in the treatment of different types of diabetes in pregnancy. Also, despite ongoing research on treatment of diabetes in pregnancy for decades, changes in the characteristics of the patient population have highlighted the limited effectiveness of different therapies. Specifically, despite the co-occurrence of obesity and diabetes, treatment recommendations including glycemic targets are not altered in such cases and a single optimal treatment strategy for each type of diabetes in pregnancy does not seem to exist. Rather, the approach to treating pregnant women with diabetes likely needs to be individualized to maximize the short term and long term health of mother and child. This article will review recent clinical studies to summarize established treatment strategies and introduce novel therapies for diabetes in pregnancy.

Footnotes

  • Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

  • Contributors: MNF and CMS both did the literature search, wrote the draft article, and revised the manuscript. They are both guarantors.

  • Funding: MNF is supported by the National Institutes of Health through grant number KL2 TR001856. The funding source had no involvement in the preparation, analysis, and interpretation of the data or submission of this review.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: none.

  • Provenance and peer review: Commissioned; externally peer reviewed.

  • Patient involvement: No patients were asked for input in the creation of this article.

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