Management of sulfonylurea-treated monogenic diabetes in pregnancy: implications of placental glibenclamide transfer.

2.50
Hdl Handle:
http://hdl.handle.net/11287/620358
Title:
Management of sulfonylurea-treated monogenic diabetes in pregnancy: implications of placental glibenclamide transfer.
Authors:
Shepherd, Maggie ( 0000-0003-2660-0955 ) ; Brook, A J; Chakera, Ali J.; Hattersley, Andrew T.
Abstract:
The optimum treatment for HNF1A/HNF4A maturity-onset diabetes of the young and ATP-sensitive potassium (KATP ) channel neonatal diabetes, outside pregnancy, is sulfonylureas, but there is little evidence regarding the most appropriate treatment during pregnancy. Glibenclamide has been widely used in the treatment of gestational diabetes, but recent data have established that glibenclamide crosses the placenta and increases risk of macrosomia and neonatal hypoglycaemia. This raises questions about its use in pregnancy. We review the available evidence and make recommendations for the management of monogenic diabetes in pregnancy. Due to the risk of stimulating increased insulin secretion in utero, we recommend that in women with HNF1A/ HNF4A maturity-onset diabetes of the young, those with good glycaemic control who are on a sulfonylurea per conception either transfer to insulin before conception (at the risk of a short-term deterioration of glycaemic control) or continue with sulfonylurea (glibenclamide) treatment in the first trimester and transfer to insulin in the second trimester. Early delivery is needed if the fetus inherits an HNF4A mutation from either parent because increased insulin secretion results in ~800-g weight gain in utero, and prolonged severe neonatal hypoglycaemia can occur post-delivery. If the fetus inherits a KATP neonatal diabetes mutation from their mother they have greatly reduced insulin secretion in utero that reduces fetal growth by ~900 g. Treating the mother with glibenclamide in the third trimester treats the affected fetus in utero, normalising fetal growth, but is not desirable, especially in the high doses used in this condition, if the fetus is unaffected. Prospective studies of pregnancy in monogenic diabetes are needed.
Citation:
Management of sulfonylurea-treated monogenic diabetes in pregnancy: implications of placental glibenclamide transfer. 2017 Diabet. Med.
Publisher:
Wiley
Journal:
Diabetic medicine : a journal of the British Diabetic Association
Issue Date:
30-May-2017
URI:
http://hdl.handle.net/11287/620358
DOI:
10.1111/dme.13388
PubMed ID:
28556992
Additional Links:
http://dx.doi.org/10.1111/dme.13388
Type:
Journal Article
Project details (details from EDGE):
EDGE Project ID: 17284
Language:
en
ISSN:
1464-5491
Appears in Collections:
Diabetes/Endocrine Services; 2017 RD&E publications

Full metadata record

DC FieldValue Language
dc.contributor.authorShepherd, Maggieen
dc.contributor.authorBrook, A Jen
dc.contributor.authorChakera, Ali J.en
dc.contributor.authorHattersley, Andrew T.en
dc.date.accessioned2017-07-10T14:52:37Z-
dc.date.available2017-07-10T14:52:37Z-
dc.date.issued2017-05-30-
dc.identifier.citationManagement of sulfonylurea-treated monogenic diabetes in pregnancy: implications of placental glibenclamide transfer. 2017 Diabet. Med.en
dc.identifier.issn1464-5491-
dc.identifier.pmid28556992-
dc.identifier.doi10.1111/dme.13388-
dc.identifier.urihttp://hdl.handle.net/11287/620358-
dc.description.abstractThe optimum treatment for HNF1A/HNF4A maturity-onset diabetes of the young and ATP-sensitive potassium (KATP ) channel neonatal diabetes, outside pregnancy, is sulfonylureas, but there is little evidence regarding the most appropriate treatment during pregnancy. Glibenclamide has been widely used in the treatment of gestational diabetes, but recent data have established that glibenclamide crosses the placenta and increases risk of macrosomia and neonatal hypoglycaemia. This raises questions about its use in pregnancy. We review the available evidence and make recommendations for the management of monogenic diabetes in pregnancy. Due to the risk of stimulating increased insulin secretion in utero, we recommend that in women with HNF1A/ HNF4A maturity-onset diabetes of the young, those with good glycaemic control who are on a sulfonylurea per conception either transfer to insulin before conception (at the risk of a short-term deterioration of glycaemic control) or continue with sulfonylurea (glibenclamide) treatment in the first trimester and transfer to insulin in the second trimester. Early delivery is needed if the fetus inherits an HNF4A mutation from either parent because increased insulin secretion results in ~800-g weight gain in utero, and prolonged severe neonatal hypoglycaemia can occur post-delivery. If the fetus inherits a KATP neonatal diabetes mutation from their mother they have greatly reduced insulin secretion in utero that reduces fetal growth by ~900 g. Treating the mother with glibenclamide in the third trimester treats the affected fetus in utero, normalising fetal growth, but is not desirable, especially in the high doses used in this condition, if the fetus is unaffected. Prospective studies of pregnancy in monogenic diabetes are needed.en
dc.language.isoenen
dc.publisherWileyen
dc.relation.urlhttp://dx.doi.org/10.1111/dme.13388en
dc.rightsArchived with thanks to Diabetic medicine : a journal of the British Diabetic Association. This is the peer reviewed version of the following article: Shepherd, M; Brook, AJ, Chakera, AJ, Hattersley, AT. Management of sulfonylurea-treated monogenic diabetes in pregnancy: implications of placental glibenclamide transfer, Diabetic Medicine, 2017 Epub May 30, which has been published in final form at: http://dx.doi.org/10.1111/dme.13388. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.en
dc.subjectWessex Classification Subject Headings::Endocrinology::Diabetesen
dc.titleManagement of sulfonylurea-treated monogenic diabetes in pregnancy: implications of placental glibenclamide transfer.en
dc.typeJournal Articleen
dc.identifier.journalDiabetic medicine : a journal of the British Diabetic Associationen
dc.description.fundingWellcome Trust & NIHRen
dc.type.versionIn press (epub ahead of print)en
dc.description.projectreferencenumberEDGE Project ID: 17284en

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