Antidiabetic Medications in Pregnancy

Medications to Avoid

• ACE inhibitors and angiotensin receptor blockers (ARBs) are absolutely contraindicated in pregnancy due to associations with fetal renal anomalies, oligohydramnios, and fetal death, as recommended by the American Academy of Family Physicians and the American Diabetes Association 1, 2, 3
• Statins must be discontinued in all sexually active women of childbearing age who are not using reliable contraception, according to the American Diabetes Association 2, 3
• The American Diabetes Association guidelines state that most oral antidiabetic agents should be stopped and insulin initiated, due to lack of long-term safety data 1

Acceptable Oral Agents

• Metformin may be continued during the preconception period and potentially throughout pregnancy, as it does not increase fetal anomalies and may reduce neonatal hypoglycemia and maternal weight gain, according to the American Academy of Family Physicians and the American Diabetes Association 1, 2
• Glyburide is widely used in pregnancy alongside insulin and metformin, and is more effective than metformin at lowering blood glucose, although it may have higher treatment failure rates 2

Preconception Medication Review

• Review all medications for teratogenic potential, including ACE inhibitors, ARBs, statins, and atenolol, and discontinue potentially harmful agents before conception in sexually active women not using reliable contraception, as recommended by the American Academy of Family Physicians and the American Diabetes Association 1, 2, 3
• Aim for hemoglobin A1C <7% before conception and <6% during pregnancy to minimize risk of congenital anomalies, according to the American Diabetes Association 2

Medications to Avoid in Pregnancy

• Do not continue ACE inhibitors or ARBs, even if blood pressure control is suboptimal—switch to methyldopa, labetalol, or long-acting nifedipine, as recommended by the American Academy of Family Physicians 1
• Avoid atenolol for hypertension management as it is associated with fetal growth restriction and lower birth weight, according to the American Academy of Family Physicians and the American Diabetes Association 1, 4