Antidiabetic drugs have been shown to be safe for pregnant women
Taking antidiabetic drugs during pregnancy did not increase the risk of congenital anomalies. Swedish scientists came to this conclusion after studying a cohort of more than 50,000 pregnant women. Among the drugs studied were the popular GLP-1 receptor agonists. The study was published in JAMA Internal Medicine.
Type 2 diabetes mellitus is becoming increasingly common in women of reproductive age, leading to an increase in the use of antidiabetic medications during pregnancy. Typically, pregnant women are prescribed insulin as well as non-insulin drugs such as metformin, sulfonylurea derivatives, dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists, and sodium-glucose cotransporter 2 (SGLT2) inhibitors. However, limited data are available on the safety of non-insulin drugs for fetal development.
A team of scientists led by Carolyn Cesta of the Karolinska Institute combined data from six large population databases from four Scandinavian countries, the United States and Israel to compare the risk of birth defects in women who took insulin and second-line (non-insulin) antidiabetic drugs during pregnancy.
A total of 51826 women with type 2 diabetes were included in the study. Of these, 15148 received antidiabetic drugs (including insulin) before or after conception (i.e., in the first trimester of pregnancy) - 7440 took metformin alone, 5078 took insulin, 1352 received sulfonylurea derivatives, 687 were prescribed DPP-4 inhibitors, 938 took GLP-1 receptor agonists, and 335 took SGLT2 inhibitors.
Statistical analysis showed that the relative risk of birth defects was no higher in children whose mothers took second-line antidiabetic drugs than in children whose mothers took insulin. Separately, the researchers examined the risk of heart defects, but again there was no increased risk.
This large cohort study shows that taking second-line antidiabetic drugs during pregnancy is safe for the fetus, allowing pregnant women to access a wider range of drugs in the future.
At the same time, one should not refuse to take medications during pregnancy: impaired carbohydrate metabolism threatens complications for the fetus. For example, an American study showed that gestational diabetes and pre-eclampsia during pregnancy are associated with a decrease in the epigenetic age of newborns.