J Korean Diabetes.  2016 Dec;17(4):277-281. 10.4093/jkd.2016.17.4.277.

A Pregnant Woman with Type 2 Diabetes Unintentionally Exposed to Metformin and Voglibose until the Second Trimester of Pregnancy: A Case Report

• Kim YU
• Kwak JH
• Yeo SH
• Moon SS
• Lee YS

• KMID: 2362987
• DOI: http://doi.org/10.4093/jkd.2016.17.4.277

Abstract

Use of oral hypoglycemic agents during pregnant women with type 2 diabetes is controversial due to safety issues. Recently, randomized controlled trials support short-term safety of glyburide and metformin for the treatment of gestational diabetes mellitus. However, long-term safety data are not available. Moreover, use of oral hypoglycemic agents, except for metformin and glyburide, during pregnancy were limited to a few case reports. We report the case of a pregnant woman with type 2 diabetes unintentionally exposed to metformin and voglibose in addition to lercanidipine and bisoprolol during fetal organogenesis. The patient was continuously exposed to oral agents because we were not aware of her pregnancy until 22 weeks of gestation. After pregnancy was confirmed, we replaced oral hypoglycemic agents with insulin and discontinue betablockers. Delivery occurred without maternal or fetal complications.

Keyword

Diabetes mellitus type 2; Hypoglycemic agents; Pregnancy

MeSH Terms

Bisoprolol
Diabetes, Gestational
Female
Glyburide
Humans
Hypoglycemic Agents
Insulin
Metformin*
Organogenesis
Pregnancy
Pregnancy Trimester, Second*
Pregnancy*
Pregnant Women*
Bisoprolol
Glyburide
Hypoglycemic Agents
Insulin
Metformin

Reference

References

1. American Diabetes Association. Management of diabetes in pregnancy. Diabetes Care. 2015; 38(Suppl 1):S77–9.

2. Holt RI, Lambert KD. The use of oral hypoglycaemic agents in pregnancy. Diabet Med. 2014; 31:282–91.

3. Yaris F, Yaris E, Kadioglu M, Ulku C, Kesim M, Kalyoncu NI. Normal pregnancy outcome following inadvertent exposure to rosiglitazone, gliclazide, and atorvastatin in a diabetic and hypertensive woman. Reprod Toxicol. 2004; 18:619–21.

4. Kolagasi O, Sari F, Akar M, Sari R. Normal pregnancy and healthy child after continued exposure to gliclazide and ramipril during pregnancy. Ann Pharmacother. 2009; 43:147–9.

5. HAPO Study Cooperative Research Group. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008; 358:1991–2002.

6. Langer O, Conway DL, Berkus MD, Xenakis EM, Gonzales O. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med. 2000; 343:1134–8.

7. Rowan JA, Hague WM, Gao W, Battin MR, Moore MP. MiG Trial Investigators. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med. 2008; 358:2003–15.

8. Vanky E, Salvesen KA, Heimstad R, Fougner KJ, Romundstad P, Carlsen SM. Metformin reduces pregnancy complications without affecting androgen levels in pregnant polycystic ovary syndrome women: results of a randomized study. Hum Reprod. 2004; 19:1734–40.

9. Morin-Papunen L, Rantala AS, Unkila-Kallio L, Tiitinen A, Hippeläinen M, Perheentupa A, Tinkanen H, Bloigu R, Puukka K, Ruokonen A, Tapanainen JS. Metformin improves pregnancy and live-birth rates in women with polycystic ovary syndrome (PCOS): a multicenter, double-blind, placebo-controlled randomized trial. J Clin Endocrinol Metab. 2012; 97:1492–500.

10. Coustan DR. Pharmacological management of gestational diabetes: an overview. Diabetes Care. 2007; 30(Suppl 2):S206–8.

11. Wilton LV, Pearce GL, Martin RM, Mackay FJ, Mann RD. The outcomes of pregnancy in women exposed to newly marketed drugs in general practice in England. Br J Obstet Gynaecol. 1998; 105:882–9.

12. Towner D, Kjos SL, Leung B, Montoro MM, Xiang A, Mestman JH, Buchanan TA. Congenital malformations in pregnancies complicated by NIDDM. Diabetes Care. 1995; 18:1446–51.

13. Podymow T, August P. Update on the use of antihypertensive drugs in pregnancy. Hypertension. 2008; 51:960–9.