Gestational diabetes mellitus

Carbohydrate metabolism disorder first detected during pregnancy and not meeting criteria for overt diabetes. Diagnosed by the 24–28 weeks oral glucose tolerance test.

ICD-10 O24.42 drugs

Also known as: GDM

Drugs used for this condition

BInsulin detemirSecond line · Long-acting insulin analogueWhen diet and activity no longer hold target glucose in diabetes during pregnancy, insulin is added. Detemir has more pregnancy data than most basal analogues: the AEMPS Levemir label reports a randomised trial in pregnant women with type 1 diabetes where detemir did not differ from NPH in pregnancy outcomes or neonatal condition. Insulin does not cross the placenta, and the requirement shifts by trimester: usually lower in the first and rising from the second. The dose is revisited at every stage and cut sharply after delivery, when the requirement returns to its pre-pregnancy level.

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

FGlibenclamideNot recommended · Oral hypoglycemic agents. SulfonylureasGlibenclamide is not first-line for gestational diabetes. ADA 2024 and Russian clinical guidelines specify insulin as the agent of choice. Metformin is a possible alternative in selected patients after discussion with the endocrinologist and obstetrician. Glibenclamide crosses the placenta in clinically significant amounts and is associated with higher rates of neonatal hypoglycemia and fetal macrosomia versus insulin (Cochrane 2017).

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit