Medication Management in Pregnant Women with Diabetes

Medications to Discontinue

The American Diabetes Association recommends stopping ACE inhibitors and ARBs immediately upon pregnancy confirmation to avoid fetal renal dysplasia, oligohydramnios, pulmonary hypoplasia, intrauterine growth restriction, and fetal death 1
Statins must be discontinued at the first pregnancy visit as they are pregnancy category X and contraindicated in all sexually active women of childbearing age not using reliable contraception 2
Atenolol should be stopped due to its association with fetal growth restriction and lower birth weight 3

Metformin may be continued throughout pregnancy if already in use, as it does not increase fetal anomalies and may reduce neonatal hypoglycemia and maternal weight gain 2
Glyburide may be continued alongside insulin if already in use, but should be discontinued at least two weeks before expected delivery date due to risk of prolonged neonatal hypoglycemia 2
Insulin should be continued and optimized as first-line therapy for all women with preexisting diabetes in pregnancy 3

Methyldopa, labetalol, and long-acting nifedipine are recommended as first-line options for blood pressure control 1
Target blood pressure should be 110-135/85 mmHg to balance maternal hypertension risk against fetal growth impairment 1

Low-dose aspirin (100-150 mg daily) should be started at 12-16 weeks gestation to reduce preeclampsia risk 5

Medication review must occur immediately upon pregnancy confirmation to minimize teratogenic exposure 2
Contraception counseling is essential for all women with diabetes of childbearing potential until medications are optimized and glycemic goals achieved (A1C <6.5%, ideally <6%) 2