NEJM 361:1339-48, 2009 Clarify that insulin is Citation #23 (Chapter Vanky E, Zahlsen K, treatment of choice. 12) Spigset O, Carlsen SM: Placental passage of This proposed metformin in women modification is based on with polycystic ovary Concentration of Since this systematic syndrome. Fertility metformin on the fetal review suggested that Sterility side of the placenta to metformin has a more levels similar to or twice favorable short term those in the maternal outcome profile than circulation. glibenclamide, but Charles B, Norris R, Xiao metformin appears to X, Hague W. Population Glyburide levels in cord be concentrated on the pharmacokinetics of blood have been shown fetal side of the metformin in late to be approximately placenta, it may be pregnancy. Ther Drug 70% of simultaneous better (prudent) to be Monit 2006; 28: 67-72. maternal level. non-directive about the choice between the two when patients decline Hebert MF et al: Are we to take insulin optimizing gestational injections. diabetes treatment with glyburide? Clinical Pharmacology & Therapeutics 2009 Potentially teratogenic Citations about statin, Taguchi N, Rubin ET, medications (ACE ACE-inhibitors and ARBs Hosokawa A, Choi J, inhibitors, statins, etc.) use in pregnancy Ying AY, Moretti ME, et should be avoided in al. Prenatal exposure to sexually active women HMG-CoA reductase of childbearing age who inhibitors: effects on are not using reliable fetal and neonatal contraception. B outcomes. Reprod Toxicol 2008;26:175–7. Bateman BT, Hernandez-Diaz S, Fischer MA et al. Statins and congenital malformations: cohort study. BMJ. 2015 Mar 17;350:h1035
NEJM 361:1339-48, 2009 Clarify that insulin is treatment of choice. This proposed modification is based on Concentration of metformin on the fetal side of the placenta to levels similar to or twice those in the maternal circulation. Glyburide levels in cord blood have been shown to be approximately 70% of simultaneous maternal level. Citation #23 (Chapter 12) Since this systematic review suggested that metformin has a more favorable short term outcome profile than glibenclamide, but metformin appears to be concentrated on the fetal side of the placenta, it may be better (prudent) to be non-directive about the choice between the two when patients decline to take insulin injections. Vanky E, Zahlsen K, Spigset O, Carlsen SM: Placental passage of metformin in women with polycystic ovary syndrome. Fertility Sterility Charles B, Norris R, Xiao X, Hague W. Population pharmacokinetics of metformin in late pregnancy. Ther Drug Monit 2006; 28: 67-72. Hebert MF et al: Are we optimizing gestational diabetes treatment with glyburide? Clinical Pharmacology & Therapeutics 2009 Potentially teratogenic medications (ACE inhibitors, statins, etc.) should be avoided in sexually active women of childbearing age who are not using reliable contraception. B Citations about statin, ACE-inhibitors and ARBs use in pregnancy Taguchi N, Rubin ET, Hosokawa A, Choi J, Ying AY, Moretti ME, et al. Prenatal exposure to HMG-CoA reductase inhibitors: effects on fetal and neonatal outcomes. Reprod Toxicol 2008;26:175–7. Bateman BT, Hernandez-Diaz S, Fischer MA et al. Statins and congenital malformations: cohort study. BMJ. 2015 Mar 17;350:h1035
2017_evidence_table_master_0.docx