Managing Type 2 Diabetes in Pregnancy: A Review of Current and Novel Therapies

Type 2 Diabetes Mellitus (T2DM) affects an estimated 2% of all pregnancies, posing significant risks for both mother and baby, leading to numerous adverse perinatal outcomes such as macrosomia, preeclampsia, and neonatal hypoglycemia. While glycemic monitoring and strict glycemic control are crucial for improving outcomes, the current management landscape primarily relies on insulin therapy. This review specifically addresses the knowledge gap regarding the safety and efficacy of newer antidiabetic medications, such as GLP-1 receptor agonists and SGLT2 inhibitors, for managing T2DM during pregnancy.

The review confirmed that insulin remains the mainstay of T2DM treatment in pregnancy, largely due to its established safety profile and extensive clinical experience. A critical finding was the limited data available for newer antidiabetic medications, highlighting a significant evidence void despite T2DM affecting an estimated 2% of all pregnancies. The review unequivocally found that robust clinical trial data on the safety and efficacy of GLP-1 RAs, tirzepatide, SGLT2i, and DPP-4i for managing T2DM in pregnant individuals is notably scarce, preventing their widespread recommendation. This scarcity means that while these novel therapies show promise in non-pregnant populations, their risk-benefit profile during pregnancy is largely undetermined, contrasting sharply with the well-documented benefits of insulin therapy. The current literature provides insufficient evidence to support their routine use, emphasizing the need for cautious consideration and further research.