Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

Which injectable agent is considered the safest for a pregnant woman with gestational diabetes?

1. Liraglutide

2. NPH insulin

3. Metformin

4. Glyburide

The correct answer is: NPH insulin

In the context of gestational diabetes, insulin is generally the preferred treatment option due to its long-established safety profile for both the mother and the developing fetus. NPH insulin, a type of intermediate-acting insulin, has been used safely in pregnant women for many years. Its mechanism of action effectively manages blood glucose levels without crossing the placenta, thereby minimizing potential risks to the fetus. While liraglutide and other options like metformin and glyburide are effective for managing diabetes, they are less favored during pregnancy. Liraglutide, for example, belongs to the GLP-1 receptor agonist class, and evidence regarding its safety in pregnancy is limited. Metformin is sometimes used but is not as well-studied in the context of gestational diabetes as insulin. Glyburide, although an oral hypoglycemic agent often used in the management of type 2 diabetes, has concerns about its safety profile for maternal and fetal outcomes. Thus, the choice of NPH insulin as the safest injectable agent in this scenario is based on its proven track record and established guidelines that prioritize maternal and fetal health during pregnancy.