Overview of safety of drugs used for diabetes during pregnancy

Review the safety of all drugs taken by women with diabetes before conception or as soon as pregnancy is recognised. This includes antihyperglycaemic drugs, and drugs given for complications associated with diabetes (eg lipid-modifying drugs, blood pressure–lowering drugs, drugs for painful diabetic neuropathy).

Note: Review the safety of all drugs taken by women with diabetes who are pregnant or planning pregnancy.

Some commonly required changes to drug treatment for diabetes during pregnancy lists some commonly required changes to drug treatment for diabetes during pregnancy.

Do not stop all noninsulin antihyperglycaemic drug(s) suddenly in early pregnancy, as this will lead to deterioration of the glycaemic profile. For more information, see Antihyperglycaemic drug treatment during pregnancy for women with pre-existing diabetes.

Note: Do not stop all noninsulin antihyperglycaemic drug(s) suddenly in early pregnancy.

Table 1. Some commonly required changes to drug treatment for diabetes during pregnancy
[NB1]
Drug class	Change required during pregnancy
antihyperglycaemic drugs
insulin	discuss with the treating specialist to ensure appropriate choice of insulin type and regimen
metformin	discuss with the treating specialist [NB2] if continued throughout pregnancy, stop metformin before induction of or at onset of labour, or when fasting before caesarean section; restart postpartum
other antihyperglycaemic drugs	stop treatment [NB2] sulfonylureas may be continued in early pregnancy until specialist review
other drugs (see Safety of drugs used for complications of diabetes during pregnancy)
lipid-modifying drugs	stop statins and other lipid-modifying drugs
blood pressure–lowering drugs	stop ACEI and ARB
Note: ACEI = angiotensin converting enzyme inhibitors; ARB = angiotensin II receptor blockers NB1: This list is not comprehensive. All drug treatment should be reviewed before conception or as soon as pregnancy is recognised. NB2: Do not stop all noninsulin antihyperglycaemic drug(s) suddenly in early pregnancy, as this will lead to deterioration of the glycaemic profile.