The use of pharmacotherapy in pregnancies with suspected diabetic fetopathy

To review the evidence supporting incorporation of sonographic fetal measurements in deciding whether or not to add insulin to diet therapy independent of maternal glucose measures for women who have gestational diabetes.

A literature search was conducted for studies incorporating sonographic estimates of fetal measures in the selection of treatment. Only randomized controlled trials were selected for review.

Four studies meeting selection criteria were identified. Methods of randomization, sonographic measurements used to indicate the addition of insulin for treatment, and clinical endpoints differed somewhat from study to study. Most studies reported a decrease in large neonates among women whose insulin treatment was indicated by ultrasound. In each study the targeted glucose values for patients treated with insulin based on sonographic measurements were lower than for those treated exclusively with diet.

Available evidence suggests a benefit in reducing the incidence of large birth weight babies to mothers who have gestational diabetes by utilizing designated sonographic parameters in the decision to add pharmacotherapy in addition to using glucose thresholds. To support these findings, studies are needed in which glycemic targets comparing groups whose insulin treatment is based on maternal glucose results with those based on ultrasound measurements are identical.