Pregnancy – Pharmacological Problems

  • Elisabeth R. Mathiesen
  • Peter Damm

This chapter covers the use of insulin, insulin analogues, and oral hypoglycemics, as well as other drugs relevant for use before or during pregnancy and lactation in women with diabetes.


Human Insulin Insulin Glargine Polycystic Ovary Syndrome Insulin Aspart Insulin Lispro 
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  1. 1.
    Weiss PA, Kainer F, Purstner P, Zehetleitner G, Huttner U, Haas J. Anti-insulin antibodies and birthweight in pregnancies complicated by diabetes. Early Hum Dev 1998;53:145–154.CrossRefPubMedGoogle Scholar
  2. 2.
    Heise T, Heinemann L: Rapid and long-acting analogues as an approach to improve insulin therapy: An evidence-based medicine assessment. Curr Pharm Des 2001;7:1303–1325.CrossRefPubMedGoogle Scholar
  3. 3.
    Persson B, Swahn ML, Hjertberg R, Hanson U, Nord E, Nordlander E, Hansson LO: Insulin lispro therapy in pregnancies complicated by type 1 diabetes mellitus. Diabetes Res Clin Pract 2002;58:115–121.CrossRefPubMedGoogle Scholar
  4. 4.
    Wyatt JW, Frias JL, Hoyme HE, Jovanovic L, Kaaja R, Brown F, Garg S, Lee-Parritz A, Seely EW, Kerr L, Mattoo V, Tan M, IONS study group. Congenital anomaly rate in offspring of mothers with diabetes treated with insulin lispro during pregnancy. Diabet Med. 2005;22(6):803–807.CrossRefPubMedGoogle Scholar
  5. 5.
    Kitzmiller JL, Main E, Ward B, Theiss T, Petereson DL: Insulin lispro and the development of proliferative diabetic retinopathy during pregnancy (Letter). Diabetes Care 1999;22:874–876.CrossRefPubMedGoogle Scholar
  6. 6.
    Looukovaara S, Immonen I, Teramo KA, Kaaja R. Progression of retinopathy during pregnancy in type 1 diabetic women treated with insulin lispro. Diabetes Care 2003;26:1193–1198.CrossRefGoogle Scholar
  7. 7.
    Jovanovic L, Ilic S, Petitt DJ, Hugo K, Gutierrez M, Browsher RR, Bastyr EJ: Metabolic and immunologic effects of insulin lispro in gestational diabetes. Diabetes Care 1999;22:1422–1427.CrossRefPubMedGoogle Scholar
  8. 8.
    Elisabeth R. Mathiesen, Brendan Kinsley, Stephanie A. Amiel, Simon Heller, David McCance, Santiago Duran, Shannon Bellaire, Anne Raben on behalf of the Insulin Aspart Pregnancy Study Group: Maternal Glycemic Control and Hypoglycemia in Type 1 Diabetic Pregnancy: A randomized trial of insulin aspart versus human insulin in 322 pregnant women. Diabetes Care 30:771–776.Google Scholar
  9. 9.
    David McCance D, Damm P, Mathiesen ER, Kaaja K, Dunne F, Hod M, Jensen LE, Mersebach H. No increase in insulin antibodies and no clear evidence of transfer of insulin aspart across the placenta in pregnant women with type 1 diabetes. Abstrakt ADA 2007.Google Scholar
  10. 10.
    Kurtzhals P, Schaffer L, Sorensen A, Kristensen C, Jonassen I, Schmid C, Trub T: Correlations of receptor binding and metabolic and mitogenic potencies of insulin analogs designed for clinical use. Diabetes 2000;49:999–1005.CrossRefPubMedGoogle Scholar
  11. 11.
    Woolderink JM, van Loon AJ, Storms F, de Heide L, Hoogenberg K. Use of insulin glargine during pregnancy in seven type 1 diabetic women. Diabetes Care 2006;29:471–472.Google Scholar
  12. 12.
    Slocum JM, Soso MEB: Use of antidiabetic agents in pregnancy: Current practise and controversy. J Perinat Neonatal Nurs 2002:16:40–53.PubMedGoogle Scholar
  13. 13.
    Elliot B, Langer O, Schenker S, Johnson RF. Insignificant transfer of glyburide occurs across the human placenta. Am J Obest Gynecol 1991;165:807–812.Google Scholar
  14. 14.
    Langer O, Conway DL, Berkus M, Xenakis EMJ, Gonsales O. A comparison of glyburide and insulin in women with gestationel diabetes mellitus. et al. NEJM 2000;343:1135–1138.CrossRefGoogle Scholar
  15. 15.
    Vanky E et al. Placental passage of metformin in women with polycystic ovary syndrome. Fertil Steril. 2005;83:1575–1578.CrossRefPubMedGoogle Scholar
  16. 16.
    Vandermolen DT, Ratts VS, Evans WS, Stovall DW, Kauma SW, Nestler JE. Metformin increases the ovulatory rate and pregnancy rate from clomiphene citrate in patients with polycystic ovary syndrome who are resistant to clomiphene citrate alone. Fertil Steril 2001;75:310–315.CrossRefPubMedGoogle Scholar
  17. 17.
    Lilja AE, Mathiesen ER. Polycystic ovary syndrome and metformin in pregnancy. Acta Obstetrica et Gynaecologica. 2006;85:861–868.CrossRefGoogle Scholar
  18. 18.
    Coetzee EJ, Jackson WPU. Metformin in management of pregnant insulin dependent diabetics. Diabetologia 1979;16:241–245.CrossRefPubMedGoogle Scholar
  19. 19.
    Hellmuth E, Damm P, Molsted-Pedersen L. Oral hypoglycemic agents in 118 diabetic pregnancies. Diabetic Medicine 2000;17:507–511.CrossRefPubMedGoogle Scholar
  20. 20.
    Hale TW, Kristensen JH, Hackett LP, Kohan R, Ilett KF: Transfer of metformin into human milk. Diabetologia 2002:45:1504–1514.Google Scholar
  21. 21.
    Shotan A, Widerhorn J, Hurst A, Elkayam U. Risks of angiotensin-converting enzyme inhibition during pregnancy: experimental and clinical evidence, potential mechanisms, and recommendations for use. Am J Med 1994;96:451–456.CrossRefPubMedGoogle Scholar
  22. 22.
    Alwan S, Polifka JE, Friedman JM: Angiotensin II receptor antagonist treatment during pregnancy. Birth Defects Res A Clin Mol Teratol. 2005;73:123–130.CrossRefPubMedGoogle Scholar
  23. 23.
    Cooper WO, Hernandez-Diaz S, Arbogast PG, Dudley JA, Dyer S, Gideon PS, Hall K, Ray WA: Major congenital malformations after first-trimester exposure to ACE inhibitors. N Engl J Med 2006; 354:2443–2451.CrossRefPubMedGoogle Scholar
  24. 24.
    Hod M, van Dijk DJ, Karp M, Weintraub N, Rabinerson D, Bar J, Peled Y, Erman A, Boner G, Ovadia J. Diabetic nephropathy and pregnancy: the effect of ACE inhibitors prior to pregnancy on fetomaternal outcome. Nephrol Dial Transplant 1995;10:2328–2333.PubMedGoogle Scholar
  25. 25.
    Nielsen LR, Muller C, Damm P, Mathiesen ER. Reduced prevalence of preterm delivery in women with diabetes type 1 and microalbuminuria – possible effect of early antihypertensive treatment during pregnancy. Diabetic Medicine 2006;23:426–431.CrossRefPubMedGoogle Scholar
  26. 26.
    National High Blood Pressure Education Program. National Institutes of Health Publication No. 00–3029. Revised 2000.Google Scholar
  27. 27.
    Khandelwai M, Kumanova M, Gaughan JP, Reece EA: Role of diltiazem in pregnant women with chronic renal disease. J Matern Fetal Neonatal Med 2002;12:408–412.Google Scholar
  28. 28.
    Devlin RG, Fleiss PM. Captopril in human blood and breastmilk. J Clin Pharmacol 1981;21:110–113.PubMedGoogle Scholar
  29. 29.
    Rush JE, Snyder DL, Barrish A, Hichens M: Comment on Huttunen K, Gronhagen-Riska C and Fyhrquist F, 1989. Enalapril treatment of a nursing mother with slightly impaired renal function. Clin Nephrol 31: 278. Clin Nephrol 1991;35:234.Google Scholar
  30. Statins: beware during pregnancy. Prescrire Int. 2006;15:18–19.Google Scholar
  31. 31.
    Ruano R, Fontes RS, Zugiab M: Prevention of preeclampsia with low-dose aspirin – a systematic review and meta-analysis of the main randomized controlled trials. Clinics. 2005;60:407–414.CrossRefPubMedGoogle Scholar
  32. 32.
    Norgard B, Puho E, Czeizel AE, Skriver MV, Sorensen HT. Aspirin use during early pregnancy and the risk of congenital abnormalities: a population-based case-control study: Am J Obstet Gynecol 2005;192:922–923.CrossRefPubMedGoogle Scholar
  33. 33.
    Mathiesen ER, Christensen AB, Hellmuth E, Horness P, Stage E, Damm P. Insulin dose during glucocorticoid treatment for foetal lung maturation in diabetic pregnancy - test of an algorithm. Acta Obstet Gynecol Scand 2002;81:835–839.CrossRefPubMedGoogle Scholar
  34. 34.
    Worldwide Atosiban versus Beta-agonists Study Group. Effectiveness and safety of the oxytocin antagonist atosiban versus beta-adrenergic agonists in the treatment of preterm labour. The Worldwide Atosiban versus Beta-agonists Study Group. BJOG 2001;108:133–142.CrossRefGoogle Scholar
  35. 35.
    Ray JG, Vermeulen MJ, Meier C, Wyatt PR: Risk of congenital anomalies detected during antenatal serum screening in women with pregestational diabetes. QJM 2004;97:651–653.CrossRefPubMedGoogle Scholar
  36. 36.
    Wentzel P, Gareskog M, Eriksson UJ: Folic acid supplementation diminishes diabetes- and glucose-induced dysmorphogenesis in rat embryos in vivo and in vitro. Diabetes 2005;54:546–553.CrossRefPubMedGoogle Scholar
  37. 37.
    Damm P, Mathiesen E, Clausen TD, Pedersen KR. Contraception for women with diabetes mellitus. Metabolic Syndrome and Related Disorders 2005;3: 244–249.CrossRefPubMedGoogle Scholar
  38. 38.
    Damm P, Mathiesen ER, Petersen KR, Kjos S. Contraception after GDM. Diabetes Care in press 2007.Google Scholar
  39. 39.
    World Health Organisation. Medical eligibility criteria for contraceptive use. 3rd Edition WHO, Geneva, Switzerland 2004.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Elisabeth R. Mathiesen
    • 1
  • Peter Damm
    • 1
  1. 1.Department of EndocrinologyUniversity of CopenhagenDenmark

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