Pharmacological therapy for Gestational Diabetes Mellitus: A comprehensive overview

Abstract

Gestational diabetes mellitus (GDM) is a prevalent metabolic condition affecting pregnant women, impairing glucose tolerance, and causing short- and long-term effects on mother, fetus, and neonate. The goal of management therapy during pregnancy is to obtain optimal glycemic control by preventing hyperglycemia and maintaining safety. The increasing prevalence of GDM worldwide is a rising concern, underscoring the need for dietary adjustments and improved detection, diagnostic and treatment strategies to overcome adverse consequences. International guidelines recommend pharmaceutical interventions for GDM when lifestyle adjustments do not attain glycemic control. Insulin is first-line treatment, but oral anti-hyperglycemic medications serve as often-used alternatives. Metformin and glyburide effectively regulate increased blood glucose in pregnancy. Metformin is preferred due to its ease of administration, reduced risk of hypoglycemia, and potential for improved long-term outcomes. Whereas glyburide is administered cautiously due to potential feto-maternal risk. In this review, the pharmaceutical alternatives for GDM have been discussed in detail, along with pharmacology and pharmacokinetics. The effects of metabolic and glycemic control on feto-maternal morbidity have also been elaborated, along with efficacy as well as side effects and long-term outcomes. However, their long-term safety profiles and fetal exposure remain unclear. By focusing on this research gap, we can explore effective management therapy by evaluating feto-maternal long-term outcomes through follow-up studies, comparing efficacy of pharmacological interventions, pharmacogenomics, digital health technologies, emerging pharmaceutical alternatives (GLP-1-Ra & SGLT-2 inhibitors), and personalized medicine. By incorporating these advancements into clinical practice by healthcare professionals, the risk of adverse effects may decrease to improve health and well-being.