Effects of in-utero exposure to oral hypoglycaemic drugs

Piacquadio, Kathleen; Hollingsworth, Dorothy R.; Murphy, H.

doi:10.1016/0140-6736(91)91512-s

Cited by 129 publications

(54 citation statements)

References 12 publications

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“…Sulphonylureas are rarely used in the treatment of gestational diabetes because of reports of neonatal hypoglycaemia and a presumed, but not documented, human teratogenic effect (1)(2)(3). In most reports, however, maternal intake of sulphonylureas until delivery has not been associated with neonatal hypoglycaemia, and this has never been reported for tolbutamide except for cases in which maternal glucose control was not described (4,5).…”

Section: Introductionmentioning

confidence: 97%

Prolonged elimination of tolbutamide in a premature newborn with hyperinsulinaemic hypoglycaemia

Christesen

Melander²

1998

European Journal of Endocrinology

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So far, gestational diabetes treated with tolbutamide has never been associated with severe hypoglycaemia in the newborn when the mother's diabetes was well controlled. We report a case of a premature neonate, gestational age 34 weeks, with severe and long-standing hypoglycaemia from birth. The mother had well-controlled gestational diabetes, treated with tolbutamide from the 24th week of gestation until delivery. The neonate had inappropriately high levels of serum proinsulin, insulin and C-peptide relative to blood glucose concentrations. From day 19 after birth, the levels were normalized. Serum tolbutamide was 140.6 mmol/l (38 mg/ml) at 3 h after birth. Zero-order kinetics were seen during the first 90 postnatal hours. The half-life of serum tolbutamide decreased from 46 to 6 h. It is suggested that tolbutamide, when given to the mother until delivery, may cause severe and prolonged hyperinsulinaemic hypoglycaemia in premature neonates. The initially prolonged tolbutamide half-lives and zero-order kinetics suggest immaturity of hepatic elimination during the first 2 days of postnatal life. European Journal of Endocrinology 138 698-701

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Section: Introductionmentioning

confidence: 97%

Prolonged elimination of tolbutamide in a premature newborn with hyperinsulinaemic hypoglycaemia

Christesen

Melander²

1998

European Journal of Endocrinology

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“…Recently, we showed that water extracts of M. charantia fruit, if administered during mid-pregnancy (days 7-14) to rats, induced prenatal growth deficiencies (8) and mild teratogenesis (9), as reported with some clinically used antidiabetic drugs in Western medicine (10). Regrettably, the possible harmful effects on pregnancy outcome after in utero exposure to a water extract of S. reticulata have not been investigated.…”

Section: Introductionmentioning

confidence: 99%

Adverse pregnancy outcome in rats following exposure to a Salacia reticulata (Celastraceae) root extract

Ratnasooriya

Jayakody

Premakumara

2003

Braz J Med Biol Res

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The root extract of Salacia reticulata Wight (family: Celastraceae) is used in Sri Lanka by traditional practitioners as a herbal therapy for glycemic control even during pregnancy. It is recognized that some clinically used antidiabetic drugs have harmful effects on pregnancy but the effects of the S. reticulata root extract on reproductive outcome is unknown and deserves examination. We determined the effects of the S. reticulata root extract on the reproductive outcome of Wistar rats (250-260 g) when administered orally (10 g/kg) during early (days 1-7) and mid-(days 7-14) pregnancy. The root extract significantly (P<0.05) enhanced post-implantation losses (control vs treatment: early pregnancy, 4.7 ± 2.4 vs 49.3 ± 13%; mid-pregnancy, 4.7 ± 2.4 vs 41.7 ± 16.1%). Gestational length was unaltered but the pups born had a low birth weight (P<0.05) (early pregnancy, 6.8 ± 0.1 vs 5.3 ± 0.1 g; mid-pregnancy, 6.8 ± 0.1 vs 5.0 ± 0.1 g) and low birth index (P<0.05) (early pregnancy, 95.2 ± 2.4 vs 50.7 ± 12.9%; mid-pregnancy, 95.2 ± 2.4 vs 58.3 ± 16.1%), fetal survival ratio (P<0.05) (early pregnancy, 95.2 ± 2.4 vs 50.7 ± 12.9; mid-pregnancy, 95.2 ± 2.4 vs 58.3 ± 16.1), and viability index (P<0.05) (early pregnancy, 94.9 ± 2.6 vs 49.5 ± 12.5%; mid-pregnancy, 94.9 ± 2.6 vs 57.1 ± 16.1%). However, the root extract was non-teratogenic. We conclude that the S. reticulata root extract can be hazardous to successful pregnancy in women and should not be used in pregnancy complicated by diabetes.

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“…Not only are some women continuing to take oral glucose-lowering medication while pregnant, but a considerable number of women may also use anti-hypertensive and antihyperlipidemic drugs. Some of these drugs are associated with congenital malformations [20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Pregnancy Outcome in Type 2 Diabetes Mellitus: A Retrospective Analysis from the Netherlands

Valk

Nieuwaal²,

Visser³

2006

Rev Diabetic Stud

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■ AbstractMAIN OBJECTIVES: The objective was to describe pregestational history and the maternal, fetal and neonatal outcome in pregnancies in women with pre-gestational type 2 diabetes during the period between 1992 and 2006 from one center in the Netherlands. METHODS: Patients attending the obstetric-diabetology outpatient clinic of a tertiary referral center were studied. This center also has a regular diabetes clinic and a community midwifery service. Patients were identified from the database. Maternal outcome (preeclampsia, pre-term delivery, Caesarean section) and fetal and neonatal outcome (macrosomia, congenital malformations, perinatal mortality, neonatal hypoglycemia) were analyzed as well HbA1c levels, planning of pregnancy, gestational age at first antenatal visit and ethnic background. RESULTS: Sixtysix singleton pregnancies from 48 women were analyzed. Their age was 34 ± 5 yr, the BMI 31.7 ± 7.4 and the median duration of diabetes was 3 yr. 52% were Caucasian and 35% were of Moroccan descent. 49% did not complete secondary school. Moroccan descent was associated with a lower educational level and a BMI comparable with the whole study group. The proportion of planned pregnancies was approximately 70%. The mean HbA1c in the first trimester was 6.4 ± 1.1% and the gestational age at first visit was 10 ± 5 wk, in one-quarter before 6 wk. The prevalences of variables related to maternal and neonatal outcome were as follows: spontaneous abortion 13.6%, pre-eclampsia 8.9%, preterm delivery 21.4%, spontaneous labor 25.0%, induced labor 48.2%, Caesarean section 42.9%, macrosomia (≥90 th percentile) 41.1%, severe hypoglycemia 41.5% and major congenital malformations 5.1%. CONCLUSIONS: Pregestational type 2 diabetes is associated with an increased incidence of adverse pregnancy outcome despite reasonable mean HbA1c level and despite a high frequency of planned pregnancies. Many women report relatively late. Improvement in the outcome requires more active peri-gestational specialist care and a tailored approach is required towards migrant communities.

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Effects of in-utero exposure to oral hypoglycaemic drugs

Cited by 129 publications

References 12 publications

Prolonged elimination of tolbutamide in a premature newborn with hyperinsulinaemic hypoglycaemia

Prolonged elimination of tolbutamide in a premature newborn with hyperinsulinaemic hypoglycaemia

Adverse pregnancy outcome in rats following exposure to a Salacia reticulata (Celastraceae) root extract

Pregnancy Outcome in Type 2 Diabetes Mellitus: A Retrospective Analysis from the Netherlands

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