Use of Noninsulin Antidiabetic Meds Increasing for T2D in Pregnancy

WEDNESDAY, Dec. 13, 2023 (HealthDay News) -- Use of second-line noninsulin antidiabetic medications (ADMs) is increasing for type 2 diabetes (T2D) in pregnancy, but use is not associated with a significantly increased risk for major congenital malformations (MCMs), according to a study published online Dec. 11 in JAMA Internal Medicine.

Carolyn E. Cesta, Ph.D., from the Karolinska Institute in Stockholm, and colleagues conducted an observational population-based cohort study using data from four Nordic countries, the U.S. MarketScan Database, and the Israeli Maccabi Health Services database. The relative risks for MCMs in infants were compared for periconceptional exposure to sulfonylureas, dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists, and sodium-glucose cotransporter 2 (SGLT2) inhibitors versus insulin (active comparator).

Differences were observed in periconceptional exposure to second-line noninsulin ADMs between the countries (32, 295, and 73 per 100,000 pregnancies in the Nordics, United States, and Israel, respectively), which increased during the study, especially in the United States. The researchers found that the standardized prevalence of MCMs was 3.7 and 5.3 percent in all infants and in infants born to women with T2D, respectively. Prevalence was 9.7, 6.1, 8.3, 7.0, and 7.8 percent for infants exposed to sulfonylureas, DPP-4 inhibitors, GLP-1 receptor agonists, SGLT2 inhibitors, and insulin, respectively. The adjusted relative risks were not significant for infants exposed to sulfonylureas, DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors compared with insulin.

"Our findings provide initial reassurance of safety for infants prenatally exposed to these medications," Cesta said in a statement.

Several authors disclosed ties to the pharmaceutical industry.

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