For a long time, managing diabetes during pregnancy has been a tightrope walk for expecting mothers. Due to the paucity of evidence about the safety of non-insulin anti-diabetic medication(ADM)for fetal development, insulin has historically been the recommended course of treatment for patients with type2 diabetes who are pregnant. A groundbreaking study from the Harvard Chan School brings some answers with the use of second-line anti-diabetics in early pregnancy compared with insulin use.

      Pregnant women with type 2 diabetes (T2D) have always faced tough choices. Good blood glucose control is crucial to prevent major congenital malformations (MCMs) in newborns, but the safety of noninsulin antidiabetic medications (ADMs) during pregnancy has been unclear. So, insulin has been the best option.

      This latest research is the largest study of its kind, looking at the safety of noninsulin ADMs during the first trimester of pregnancy. The study used extensive data from four Nordic countries, the US, and Israel, tracking pregnant women with T2D and their infants for up to a year after birth.

      Researchers focused on women who had taken sulfonylureas, DPP-4 inhibitors, GLP-1 receptor agonists, SGLT2 inhibitors, or insulin (as a comparison) from three months before pregnancy through the first trimester.

Key Findings:

• The overall prevalence of major congenital malformations in infants was 3.7%.
• In infants born to women with T2D, this rate was higher at 5.3%.
• Breaking it down by medication, the rates of MCMs were: 9.7% for sulfonylureas, 6.1% for DPP-4 inhibitors, 8.3% for GLP-1 receptor agonists, 7.0% for SGLT2 inhibitors, and 7.8% for insulin.
• However, when comparing these medications to insulin, the adjusted relative risks for MCMs did not show a significant increase.

      This is big news for pregnant women with T2D and their doctors. These findings suggest that noninsulin diabetes medications may not increase the risk of MCMs compared to insulin. It's a reassuring message, opening the door to more flexible and potentially easier treatment options during pregnancy.

      The research was published in 'Jama Internal Medicine'.