Insulin versus oral anti-diabetic pharmacological therapies for gestational diabetes

Insulin and oral anti-diabetic pharmacological therapies for gestational diabetes appear to have similar effects on maternal health outcomes. There might not be differences in infant outcomes, although the evidence is insufficient.

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding, and selective reporting).

Summary

A Cochrane review included 53 studies with a total of 7381 women with gestational diabetes (GDM). Insulin was associated with an increased likelihood of hypertensive disorders of pregnancy (high blood pressure - not defined) although there was no evidence of any difference in pre-eclampsia, caesarean section, developing type 2 diabetes, or postnatal weight compared with oral anti-diabetic medication (table ). For the infant, there was no evidence of a clear difference between those whose mothers had been treated with insulin and those treated with oral anti-diabetic pharmacological therapies for the risk of being born large-for-gestational age (average RR 1.01, 95% CI 0.76 to 1.35; 13 studies, n=2352). There was no difference in perinatal death, serious morbidity, neonatal hypoglycaemia, adiposity, or neurosensory disabilities in later childhood, however the evidence is insufficient.

Clinical comments

Date of latest search: 2018-04-01

Ədəbiyyat

1. Brown J, Grzeskowiak L, Williamson K et al. Insulin for the treatment of women with gestational diabetes. Cochrane Database Syst Rev 2017;(11):CD012037.