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Because of limited data on the effects of noninsulin diabetes medications on fetal development, the American Diabetes Association recommends insulin for managing type 2 diabetes in pregnancy (Diabetes Care 2023; 46:Suppl 1:S254). However, both intentional use of metformin and unintentional exposure to other second-line drugs during pregnancy have increased. In this observational, population-based study, researchers assessed noninsulin diabetes medication use and risk for major congenital malformations among 3.5 million pregnancies in six countries from 2009 to 2021.
Of 52,000 pregnant women with type 2 diabetes, 15,000 used diabetes medications between 90 days before pregnancy and the end of the first trimester. The prevalence of major conge…