Safety considerations with pharmacological treatment of XXXX .

@entity1 @entity28 @entity6 @entity5217 @entity1017 @entity413 @entity2449
The number of @entity1 with @entity6 (GDM: @entity6 first diagnosed in pregnancy) continues to grow, as do the associated risks of antenatal and postnatal complications and the chance of future @entity6 and @entity28 in both mother and offspring. Recent randomised controlled trials have demonstrated clear benefits for intensive management of GDM using lifestyle modification, self blood @entity413 monitoring, close clinical supervision and, where glycaemia remains inadequately controlled, insulin therapy. More recently, @entity2449 and @entity5217 have been shown to adequately reduce hyperglycaemia as part of a stepped approach to GDM management, with a switch to insulin therapy where necessary. Other oral medications have not been shown to be safe in pregnancy. @entity1 insulin therapy is safe within the limits of hypoglycaemia and @entity1017 . Most insulin analogues are also now considered safe for use in pregnancy (insulin lispro, aspart and detemir). @entity2449 therapy is oral, and therefore preferred to insulin, but is associated with more gastrointestinal adverse effects, although not hypoglycaemia or @entity1017 . Conversely, @entity5217 is also an oral therapy but is associated with hypoglycaemia and @entity1017 . However, @entity2449 crosses the placenta and it remains unclear whether @entity5217 crosses the placenta or not: long-term risks have not been shown, and are thought to be minimal, but further studies are needed. @entity2449 is seen by some as the treatment of choice where @entity1017 is an issue, providing that the unanswered questions over the long-term safety of oral agents have been discussed.
