10
Care During Pregnancy
5.0. Blood Glucose-Lowering Pharmacological Therapy
During Pregnancy
Insulin Therapy
Î 5.1a. ES suggests the long-acting insulin analog detemir may be
initiated during pregnancy for those women who require basal insulin
and for whom NPH insulin, in appropriate doses, has previously
resulted in, or for whom it is thought NPH insulin may result in,
problematic hypoglycemia. Insulin detemir may be continued in those
women with diabetes already successfully taking insulin detemir
before pregnancy. (2|⊕⊕⊕⊕)
Î 5.1b. ES suggests those pregnant women successfully using insulin
glargine before pregnancy may continue it during pregnancy.
(2|⊕⊕
)
Î 5.1c. ES suggests the rapid-acting insulin analogs lispro and aspart be
used in preference to regular (soluble) insulin in pregnant women with
diabetes. (2|⊕⊕⊕
)
Î 5.1d. ES recommends the ongoing use of continuous SC insulin
infusion during pregnancy in women with diabetes when this has been
initiated before pregnancy (1|⊕⊕⊕
), but suggests that continuous SC
insulin infusion NOT be initiated during pregnancy unless other insulin
strategies including multiple daily doses of insulin have first been
tried and proven unsuccessful. (2|⊕⊕
)
Noninsulin Antihyperglycemic Agent Therapy
Î 5.2a. ES suggests glyburide (glibenclamide) is a suitable alternative
to insulin therapy for glycemic control in women with gestational
diabetes who fail to achieve sufficient glycemic control after a 1-week
trial of MNT and exercise, except for those women with a diagnosis of
gestational diabetes before 25 weeks gestation and for those women
with fasting plasma glucose levels >110 mg/dL (6.1 mmol/L), in which
case insulin therapy is preferred. (2|⊕⊕
)
Î 5.2b. ES suggests metformin therapy be used for glycemic control
only for those women with gestational diabetes who do not have
satisfactory glycemic control despite MNT and who refuse or cannot
use insulin or glyburide and are not in the first trimester. (2|⊕⊕
)
