Perinatal outcomes and the use of oral hypoglycemic agents
-
Anna Maria Bertini
Abstract
Objective: To compare neonatal results from patients with gestational diabetes mellitus (GDM) who were treated with insulin, glyburide and acarbose.
Results: Seventy patients diagnosed with GDM who needed therapy to complement diet and physical activities were included in the study. One group was assigned to insulin therapy (n=27), a second group was assigned to glyburide therapy (n=24) and a third group was assigned to acarbose therapy (n=19). Maternal characteristics were similar in the three groups. Glucose control was not achieved in five (20.8%) of the patients using glyburide and in eight (42.1%) of patients using acarbose. No statistical difference was observed in fasting and post-prandial glucose levels or in average newborn weight in the three groups. The rate of large for gestational age (LGA) fetuses was 3.7, 25 and 10.5% in the groups treated with insulin, glyburide and acarbose, respectively. Neonatal hypoglycemia was observed in eight newborns, six of which from the glyburide group.
Conclusion: We believe that glyburide and acarbose can be promising alternative therapies for the treatment of GDM. Glyburide controlled glucose levels in most patients and it was more efficient than acarbose. Glyburide showed a higher rate of macrosomia and neonatal hypoglycemia as compared to other therapies.
References
1 Aberg A, H Rydhstroem, A Frid: Impaired glucose tolerance associated with adverse pregnancy outcome: a population-based study in southern Sweden. Am J Obstet Gynecol184 (2001) 77Suche in Google Scholar
2 Abernethy DR, GJ Arnold, D Azarnoff, et al.: Acarbose. Mosby's Drugs Consult [online] 2003 [citado em 12 Jul 2003];[13 telas]. Disponível em: http://home.mdconsult.comSuche in Google Scholar
3 American Diabetes Association (ADA): Gestational Diabetes mellitus. Diabetes Care 25 (2002) 94Suche in Google Scholar
4 Bertini AM: Diabetes mellitus e gravidez. In: Federação brasileira de ginecologia e obstetrícia (ed): Tratado de obstetrícia. Atheneu, São Paulo 2000Suche in Google Scholar
5 Bertini AM: Diabetes Mellitus e Gravidez. In: Rezende J. Obstetrícia. 9a ed. Guanabara Koogan, Rio de Janeiro: 2002, p. 413Suche in Google Scholar
6 Coetzee EJ, WPU Jackson: Oral hipoglycaemics in the first trimester and fetal outcome. S Afr Med J65 (1984) 635Suche in Google Scholar
7 Conselho Nacional de Saúde (CNS): Diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Resolução 196/96 1996Suche in Google Scholar
8 Conway DL, O Gonzales, D Skiver: Use of glyburide for the treatment of gestational diabetes: the San Antonio experience. J Matern Fetal Neonatal Med15 (2004) 51Suche in Google Scholar
9 Coustan DR, RL Berkowitz, JC Hobbins: Tight metabolic control of overset diabetes in pregnancy. Am J Med68 (1980) 845Suche in Google Scholar
10 Coustan DR, SB Lewis: Insulin therapy for gestational diabetes. Obstet Gynecol51 (1978) 306Suche in Google Scholar
11 Daponte A, F Guidozzi, D Moisue, A Marineanu: Management of diabetic pregnant patients in a tertiary center in the developing world. Gynecol Obstet64 (1999) 141Suche in Google Scholar
12 Fines V, T Moore, S Castle: A comparison of glyburide and insulin treatment in gestational diabetes mellitus on infant birth weight and adiposity. Am J Obstet Gynecol189 (2003) 108Suche in Google Scholar
13 Garcia-Bournissen F, DS Feig, G Koren: Maternal-fetal transport of hipoglycaemic drug. Clin Pharmacokinet42 (2003) 303Suche in Google Scholar
14 Hellmuth E, P Damm, L Molsted-Pedersen: Oral hypoglycaemic agents in 118 diabetic pregnancies. Diabet Med17 (2000) 507Suche in Google Scholar
15 Honko CJ, EA Reece: Ambulatory care of the pregnant woman with diabetes. Clin Obstet Gynecol41 (1998) 584Suche in Google Scholar
16 Jacobson JD, L Cousins: A population-based study of maternal and perinatal outcome in patients with gestational diabetes. Am J Obstet Gynecol161 (1989) 981Suche in Google Scholar
17 Jovanovic L: American diabetes association's fourth international workshop-conference on gestational diabetes mellitus: summary and discussion. Diabetes Care21 (1998) 131Suche in Google Scholar
18 Jovanovic L, DJ Pettin: Diabetes mellitus gestacional. JAMA Brasil7 (2003) 1446Suche in Google Scholar
19 Kremer CJ, P Duff: Glyburide for the treatment of gestational diabetes. Am J Obstet Gynecol190 (2004) 175Suche in Google Scholar
20 Landon MB, SG Gabbe: Diabete mélito. In: Barron WM, Lindhemeir MD (eds): Complicações médicas na gravidez. Artes Médicas, Porto Alegre 1996Suche in Google Scholar
21 Langer O: Oral hypoglycemic agents and pregnant diabetic: from bench to bedside. Semin in Perinatol26 (2002) 21510.1053/sper.2002.33960Suche in Google Scholar PubMed
22 Langer O, DL Conway, MD Berkus, EMJ Xenakis, ORN Gonzales: A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med343 (2000) 1134Suche in Google Scholar
23 Larimore WL, KA Petrie: Drugs use during pregnancy and lactation. Primary Care: Clinics in Office Practice27 (2000) 49Suche in Google Scholar
24 Ministério da Saúde: Diabetes gestacional. In: Manual de hipertensão arterial e diabetes mellitus (ed). Editora MS, Brasília 2002Suche in Google Scholar
25 Ministério da Saúde: Secretaria de políticas de saúde In: Gestação de alto risco (eds) SPS, Brasília 2000Suche in Google Scholar
26 Montenegro Jr RM, GMFG Paccola, CMFAPM Sales, APDR Montenegro, SM Jorge, G Duarte, MC Foss: Evolução materno-fetal de gestantes diabéticas seguidas no HC-FMRP-USP no período de 1992-1999. Arq Bras Endocrinol Oct45 (2001) 467Suche in Google Scholar
27 MS/SVS/DASIS – Sistema de informações sobre nascimento – SINASC [online]. [citado em 5 Dez 2003]. Disponível em: http://www.datasus.gov.brSuche in Google Scholar
28 Oppermann MLR, AJ Reichelt: Diabete mélito e gestação. In: Freitas F, Martins-costa SH, Ramos JGL, Magalhães JÁ (eds): Rotinas em obstetrícia. Artmed, Porto Alegre 2001Suche in Google Scholar
29 Platt J, W O'Brien: Acarbose therapy for gestational diabetes: a retrospective cohort study. Am J Obstet Gynecol189 (2003) 107Suche in Google Scholar
30 Reece EA, C Honko, M Miodovnik, O Langer: A consensus report of the diabetes in pregnancy study group of north america conference. J Matern Fetal Neonatal Med12 (2002) 362Suche in Google Scholar
31 Silva JC: Gestante diabética. EPUB, Rio de Janeiro 2003Suche in Google Scholar
32 Zárate A, R Ochoa, M Herández, L Basurto: Eficacia de la acarbose para controlar el deterioro de la tolerancia a la glucosa durante la gestación. Ginecol Obstet Mex68 (2000) 42Suche in Google Scholar
©2005 by Walter de Gruyter Berlin New York
Artikel in diesem Heft
- Acknowledgement
- Index Volume 33 (2005)
- The role of Fas mediated apoptosis in preeclampsia
- New data about embryonic and fetal neurodevelopment and behavior obtained by 3D and 4D sonography
- A clinical evaluation of controlled-release dinoprostone for cervical ripening – a review of current evidence in hospital and outpatient settings
- The evidence linking maternal nutrition and prematurity
- Hydroxyprogesterone caproate and progesterone increase tumor necrosis factor-alpha production in lipopolysaccharide stimulated whole blood from non-pregnant women
- Routine cervical dilatation during elective cesarean section and its influence on maternal morbidity: a randomized controlled study
- Transient hypothyroxinemia of prematurity and histological chorioamnionitis
- Perinatal outcomes and the use of oral hypoglycemic agents
- Are amniotic fluid C-reactive protein and glucose levels, and white blood cell counts at the time of genetic amniocentesis related with preterm delivery?
- Combined sonographic and endoscopic umbilical cord occlusion in twin and triplet gestations
- Regional difference of endothelium-dependent contractility in human umbilical artery
- Isolated echogenic intracardiac foci in patients with low-risk triple screen results: assessing the risk of Trisomy 21
- Neonatal screening for congenital hypothyroidism in Hessen, Germany: efficiency of the screening program and school achievement of 129 children at an age of 8–12 years
- Utility of a Doppler-derived index combining systolic and diastolic performance (Tei index) for detecting hypoxic cardiac damage in newborns
- Breast-feeding in women with hypertensive disorders in pregnancy
- Intrauterine therapy for parvovirus B19 infected symptomatic fetus using B19 IgG-rich high titer gammaglobulin
- Failure of conservative management of placenta previa-percreta
- Congress Calendar
- Nomogram of the fetal gastric size development in normal pregnancy
Artikel in diesem Heft
- Acknowledgement
- Index Volume 33 (2005)
- The role of Fas mediated apoptosis in preeclampsia
- New data about embryonic and fetal neurodevelopment and behavior obtained by 3D and 4D sonography
- A clinical evaluation of controlled-release dinoprostone for cervical ripening – a review of current evidence in hospital and outpatient settings
- The evidence linking maternal nutrition and prematurity
- Hydroxyprogesterone caproate and progesterone increase tumor necrosis factor-alpha production in lipopolysaccharide stimulated whole blood from non-pregnant women
- Routine cervical dilatation during elective cesarean section and its influence on maternal morbidity: a randomized controlled study
- Transient hypothyroxinemia of prematurity and histological chorioamnionitis
- Perinatal outcomes and the use of oral hypoglycemic agents
- Are amniotic fluid C-reactive protein and glucose levels, and white blood cell counts at the time of genetic amniocentesis related with preterm delivery?
- Combined sonographic and endoscopic umbilical cord occlusion in twin and triplet gestations
- Regional difference of endothelium-dependent contractility in human umbilical artery
- Isolated echogenic intracardiac foci in patients with low-risk triple screen results: assessing the risk of Trisomy 21
- Neonatal screening for congenital hypothyroidism in Hessen, Germany: efficiency of the screening program and school achievement of 129 children at an age of 8–12 years
- Utility of a Doppler-derived index combining systolic and diastolic performance (Tei index) for detecting hypoxic cardiac damage in newborns
- Breast-feeding in women with hypertensive disorders in pregnancy
- Intrauterine therapy for parvovirus B19 infected symptomatic fetus using B19 IgG-rich high titer gammaglobulin
- Failure of conservative management of placenta previa-percreta
- Congress Calendar
- Nomogram of the fetal gastric size development in normal pregnancy
