Diabetes is another common complication of pregnancy. How safe are drugs used to
manage this condition?
Pre-existing diabetes in this age group will almost always be controlled with insulin.
The woman will almost always be on this already. In the unlikely event that she has
used dietary control, conception will almost certainly mean a switch to insulin..
Insulin is not only safe, it is actually beneficial in preventing birth defects.
Those diabetic mothers whose diabetes had been well controlled before conception
reduce the risk of congenital malformation quite significantly. In poorly controlled
diabetics, the risk of major malformation in their children is up to three times
that of the general population.
Apart from insulin, what other drugs are used to control diabetes in pregnancy?
In non-pregnant individuals, there is a place for what are known as "oral hypoglycaemics".
These have an effect of lowering blood-sugar levels, to various degrees. Most of
them (Chlorpropamide, Glibenclamide, Gliquidone, Glipizide and Tolbutamide) cross
the placenta and are likely to cause a catastrophic fall in fetal blood-sugar. They
are not used in pregnancy.
Metformin (Glucophage®) is arguably the most commonly used oral hypoglycaemic used
in Type 2 diabetes. It is also known to cross the placenta but there is no evidence
of adverse effect when used in pregnancy. Despite this safety profile it is rarely
used in pregnancy. This is because insulin is infinitely better and more reliable.
Over the last few years, many experts have advocated programs where Metformin is
used alongside Insulin in special situations. These may include situations such as
with some very obese diabetic expectant mothers - where insulin has failed to bring
about the required control and Metformin has proved itself to be a useful supplement.
This strategy has been increasingly employed with a fair degree of success and with
no apparent adverse effects.
Systemic Lupus Erythematosus (SLE) in Pregnancy
Some people suffering from SLE are maintained on "antimalarials" such as hydroxy-chloroquine
(Plaquenil®). What is the advice regarding their use in pregnancy?
These drugs are very effective in controlling the disease. Discontinuing their use
can cause a flare-up of the disease. Moreover, such a step may increase the risk
of miscarriage or fetal death in the uterus quite substantially. It is known for
a fact that women suffering from SLE are prone to repeated pregnancy loss. Stopping
this medication will therefore not only have an adverse effect on the mother but
on the fetus as well. It is also true that there is no evidence that use of this
drug in pregnancy has any adverse effect on the baby, short or long-term. Plaquenil®
is also used for active rheumatoid arthritis.