Repaglinide, the only glinide available in Italy, is a secretagogue developed for type 2 diabetes (1). There is no evidence about its use during human pregnancy. Studies on rats that showed its effects on long bone growth excluded any teratogenity (2). More data exist regarding the safety of metformin in pregnancy, even though it is not recommended as an oral hypoglycemic agent in diabetic pregnancy (3,4).
We report two case subjects of type 2 diabetic women who used repaglinide at conception and during the first 6–7 weeks of an unplanned pregnancy.
The first patient, L.M., was 38 years old and was diagnosed with type 2 diabetes when she was 31; since 2004, she had been treated with repaglinide (1.5 mg/day) and metformin (3 g/day). When we first visited her, she was 6 weeks and 4 days into her second pregnancy, with a pregestational BMI of 26.2 kg/m2.
The second patient, N.G., was 34 years old, developed diabetes in 2001, and had been treated with repaglinide (2.5 mg/day) for 2 years. When we first visited her, she was nulliparous at the 6th gestational week, with a pregestational BMI of 21.3 kg/m2.
Both gestational ages were confirmed by ultrasound. Neither patient had evidence of micro- and macrovascular complications or autonomic neuropathy. Due to the lack of data on the safety of repaglinide in pregnancy, they were both switched to insulin. Other therapies included a multivitamin and mineral supplementation.
L.M. was given alfa metildopa beginning with the 29th week of gestation to treat gestational hypertension. At 40 weeks and 3 days, she spontaneously delivered a healthy female newborn (3,680 g, length 52 cm, cranial circumference [CC] 33 cm, and Apgar score 9/10) who developed jaundice, needing phototherapy for 1 day.
N.G. submitted to a cesarean section at her 39th gestational week and had a male newborn (2,650 g, length 45 cm, CC 33.5 cm, and Apgar score 9/10).
Both birth weights were adequate for the gestational ages, and no congenital malformations were observed. Six weeks later, they did not report neonatal or maternal morbidity.
Our experience regarding the use of repaglinide in pregnancy is limited to these two subjects, whose unplanned conception was with a good HbA1c (L.M. preconception 6.8%, conception 7%, and 3rd trimester 5.6%; N.G. conception 6.4% and 3rd trimester 5.1%; normalized variance 3–6%) obtained with the use of repaglinide from several months before conception until early pregnancy.
Repaglinide did not affect embryo development; no minor or major malformations were observed. Because of its early discontinuation, we have no data about its influence on fetal growth.
These observations do not allow us to draw any conclusions about the effects and risks of repaglinide in pregnancy.
