[Drug therapy for diabetes mellitus during pregnancy and breastfeeding in the beginning of 21 century: status quo and new challenges].

Diabetes mellitus is frequent during pregnancy and is associated with substantial risks both for the mother and the newborn. An adequate therapy ensures the normal course of pregnancy and delivery and postnatal development of the baby. Insulin, for its well known safety record, has long been considered the drug of first choice for achieving optimal glycemic control in pregnant women. Pregnancy is an indication for intensive insulin therapy. The pre-mixed insulins are not recommended due to their inability to provide the needed therapeutic flexibility during the different periods of pregnancy. The short acting insulin analogue aspart is currently registered for meal-time use in basal therapy with NPH insulin. The long-acting analogues glargine and detemir are still investigated clinically and for the moment are only used off label in pregnancy. Maternal hypoglycemia, the need of injection and the high cost are the main drawbacks of insulin therapy. Evidence has accumulated in recent years that some oral antidiabetics are as efficacious and safe as insulin in gestational diabetes. Metformin and glibenclamide are now increasingly viewed as a rational alternative to insulin therapy--a treatment both preferred by the women and a less expensive one, during pregnancy and breastfeeding.