Injected and Oral Medications Equally Safe for Gestational Diabetes

For women with gestational diabetes and their babies, there is little evidence demonstrating the superiority of injected insulin over oral medications and nonpharmacologic interventions with regard to short-term outcomes and complications, according to findings published in the Cochrane Database of Systematic Reviews.

The investigators of this review identified 53 randomized controlled trials that included 7381 mothers with gestational diabetes. Additionally, researchers found another 46 studies that provided outcomes data for 6435 infants born to mothers who had gestational diabetes during pregnancy.

Insulin therapy correlated with a higher rate of hypertension during pregnancy (risk ratio (RR) 1.89; 95% CI, 1.14-3.12); however, the researchers found no difference between insulin and oral medications with regard to risk for preeclampsia (RR 1.14; 95% CI, 0.86-1.52), type 2 diabetes development (RR 1.39; 95% CI, 0.80-2.44), or birth by caesarean section (RR 1.03; 95% CI, 0.93-1.14).

A pooled analysis of the studies did appear to demonstrate a potential association between insulin injections and an increase in labor induction compared with oral medications. No differences were observed between women receiving oral medications or insulin in relation to risk for infant mortality following birth (RR 0.85; 95% CI, 0.29-2.49), infant hypoglycemia (average RR 1.14; 95% CI, 0.85-1.52), or childhood adiposity (mean difference 0.5%; 95% CI, -0.49 to 1.49) at 18 months.

Because current evidence suggests there is no difference between oral antidiabetic medications and insulin injections on mother and infant outcomes, the investigators comment that “the choice to use one or the other may be down to physician or maternal preference, availability, or severity of gestational diabetes mellitus.”

Reference

Brown J, Grzeskowiak L, Williamson K, Downie MR, Crowther CA. Insulin for the treatment of women with gestational diabetes [published online November 5, 2017]. Cochrane Database Syst Rev. doi:10.1002/14651858.CD012037.pub2