Women with Higher BMI at Lower Risk for Glaucoma
44 WOMEN'S HEALTH SEPTEMBER 1, 2010 • FAMILY PRACTICE NEWS DRUGS, PREGNANCY, AND LACTATION Use of Antidiabetic Agents During Pregnancy n a previous column, I looked at the abinese), tolazamide (Tolinase), and tolbu- thetic analogue of human amylin given was discovered. No developmental toxi- ways uncontrolled hyperglycemia tamide (Orinase). They can cause marked by subcutaneous injection, but the ani- city was observed in the newborns. Iduring pregnancy causes significant and persistent neonatal hypoglycemia if mal data suggest moderate risk (struc- Pioglitazone (Actos) and rosiglitazone toxicity for the mother, embryo, fetus, taken close to birth. To prevent this toxi- tural anomalies in rats). The drug— (Avandia), thiazolidinediones used as ad- newborn, and adolescent (“Toxicity of city, therapy should be changed to insulin which slows the rate of gastric emptying, juncts to diet and exercise, lower insulin Diabetes in Pregnancy,” December in the third trimester or, at least, several prevents a postprandial rise in plasma resistance but do not promote insulin re- 2009, p. 52). days before birth. glucagon, and promotes satiety—is best lease. Animal reproduction data suggest This column examines the The second-generation sul- avoided in pregnancy. risk, but the human experience is too use of antidiabetic agents, fonylureas glipizide (Glu- Saxagliptin (Onglyza) and sitagliptin limited to assess the risk, so they should other than insulin, that are cotrol), glimepiride (Amaryl), (Januvia), inhibitors of the enzyme be avoided in pregnancy. used for non–insulin-depen- and glyburide (DiaBeta, Gly- dipeptidyl peptidase–4, are indicated as In summary, only metformin and gly- dent diabetes during preg- nase, and Micronase) are pre- monotherapy or in combination with buride have sufficient human pregnancy nancy and lactation.
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