Counterpoint: Oral Hypoglyemic Agents Should Be Used to Treat Diabetic Pregnant Women

It has now been established that even mild forms of gestational diabetes mellitus (GDM) (impaired glucose tolerance according to World Health Organization 1985 criteria) can cause major morbidity and even mortality if left untreated (1). As with type 2 diabetes, the prevalence of GDM has increased dramatically, linked to the worldwide obesity epidemic (2). This increase has been especially prevalent in the developing world and among indigenous populations who have adopted the unhealthy lifestyle of countries that are now part of the developed world (Maoris in New Zealand, Aborigines in Australia, and indigenous Americans in North America). The developing world, especially India but also Africa, faces an enormous increase in pregnant diabetic patients (both with GDM and with type 2 diabetes).

Specifically, Africa has neither the infrastructure nor the financial resources available to treat such large numbers of patients. If plans and appropriate protocols are not designed specifically for the needs of the pregnant population in these countries, there will be a marked increase in perinatal mortality and morbidity. It is especially the mortality, the severe birth injuries, respiratory distress syndrome, and neonatal hypoglycemia that cause concern in developing countries. Although large-for-gestational-age newborns are a very sensitive marker for good diabetic control, the prevention thereof is unlikely to be the top priority in poorly resourced countries.