Antidiabetic medication use during pregnancy: an international utilization study

Area of Science:

• Reproductive medicine
• Pharmacology
• Public health

Background:

• Diabetes in pregnancy is a growing concern.
• Treatment with antidiabetic medication (ADM) during pregnancy is increasingly necessary.
• Understanding ADM use patterns is crucial for maternal and fetal health.

Purpose of the Study:

• To assess the prevalence and patterns of antidiabetic medication (ADM) use in pregnancy.
• To analyze trends in ADM use across seven countries from 2006 onwards.

Main Methods:

• Utilized linked nationwide health registers and insurance databases from Denmark, Finland, Iceland, Norway, Sweden, Australia (New South Wales), and the US.
• Included over 5.2 million pregnancies.
• Calculated ADM prevalence based on filled prescriptions within 90 days before pregnancy or during pregnancy.

Main Results:

• Overall ADM prevalence was 3%, varying from <2% in Nordic countries to >5% in Australia and the US.
• Insulin was the most frequently used ADM, followed by metformin, which showed increasing use over time.
• Discontinuation of prepregnancy ADM occurred in 11.4%-62.5% of cases; insulin was preferred for late-pregnancy gestational diabetes, except in the US (glibenclamide).

Conclusions:

• Significant variations exist in ADM prevalence and prescribing patterns across countries and over time.
• Insulin remains the most common ADM in pregnancy, but metformin use has markedly increased.
• These findings highlight evolving treatment strategies for diabetes in pregnancy.