{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:32:02Z","timestamp":1790688722266,"version":"4.1.0"},"reference-count":38,"publisher":"BMJ","issue":"1","funder":[{"DOI":"10.13039\/501100005416","name":"Norges Forskningsr\u00e5d","doi-asserted-by":"publisher","award":["International Pregnancy Drug Safety Studies (InPre"],"award-info":[{"award-number":["International Pregnancy Drug Safety Studies (InPre"]}],"id":[{"id":"10.13039\/501100005416","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004785","name":"NordForsk","doi-asserted-by":"publisher","award":["Nordic Pregnancy Drug Safety Studies (NorPreSS) pr"],"award-info":[{"award-number":["Nordic Pregnancy Drug Safety Studies (NorPreSS) pr"]}],"id":[{"id":"10.13039\/501100004785","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2019,9,8]]},"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Diabetes in pregnancy and consequently the need for treatment with antidiabetic medication (ADM) has become increasingly prevalent. The prevalence and patterns of use of ADM in pregnancy from 2006 onward in seven different countries was assessed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research design and methods<\/jats:title>\n                  <jats:p>Data sources included individually linked data from the nationwide health registers in Denmark (2006\u20132016), Finland (2006\u20132016), Iceland (2006\u20132012), Norway (2006\u20132015), Sweden (2006\u20132015), state-wide administrative and claims data for New South Wales, Australia (2006\u20132012) and two US insurance databases: Medicaid Analytic eXtract (MAX; 2006\u20132012, public) and IBM MarketScan (2012\u20132015, private). The prevalence of ADM use was calculated as the proportion of pregnancies with at least one filled prescription of an ADM in the 90 days before pregnancy or within the three trimesters of pregnancy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Prevalence of any ADM use in 5\u2009279\u2009231 pregnancies was 3% (n=147\u2009999) and varied from under 2% (Denmark, Norway, and Sweden) to above 5% (Australia and US). Insulin was the most used ADM, and metformin was the most used oral hypoglycemic agent with increasing use over time in all countries. In 11.4%\u201362.5% of pregnancies with prepregnancy use, ADM (primarily metformin) was discontinued. When ADM treatment was initiated in late pregnancy for treatment of gestational diabetes mellitus, insulin was most often dispensed, except in the US, where glibenclamide was most often used.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Prevalence and patterns of use of ADM classes varied between countries and over time. While insulin remained the most common ADM used in pregnancy, metformin use increased significantly over the study period.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjdrc-2019-000759","type":"journal-article","created":{"date-parts":[[2019,11,2]],"date-time":"2019-11-02T10:05:22Z","timestamp":1572689122000},"page":"e000759","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":50,"title":["Antidiabetic medication use during pregnancy: an international utilization study"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5759-9366","authenticated-orcid":false,"given":"Carolyn E","family":"Cesta","sequence":"first","affiliation":[{"name":"Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline M","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Pazzagli","sequence":"additional","affiliation":[{"name":"Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian T","family":"Bateman","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Br\u00f6ms","sequence":"additional","affiliation":[{"name":"Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Internal Medicine, Danderyds Sjukhus AB, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristjana","family":"Einarsd\u00f3ttir","sequence":"additional","affiliation":[{"name":"Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari","family":"Furu","sequence":"additional","affiliation":[{"name":"Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway"},{"name":"Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alys","family":"Havard","sequence":"additional","affiliation":[{"name":"Centre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Heino","sequence":"additional","affiliation":[{"name":"Information Services Department, National Institute for Health and Welfare, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Hernandez-Diaz","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista F","family":"Huybrechts","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d8ystein","family":"Karlstad","sequence":"additional","affiliation":[{"name":"Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helle","family":"Kieler","sequence":"additional","affiliation":[{"name":"Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department for Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Aarhus Universitet, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarit K","family":"Leinonen","sequence":"additional","affiliation":[{"name":"Information Services Department, National Institute for Health and Welfare, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanne L","family":"Gulseth","sequence":"additional","affiliation":[{"name":"Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duong","family":"Tran","sequence":"additional","affiliation":[{"name":"Centre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongfu","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Aarhus Universitet, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helga","family":"Zoega","sequence":"additional","affiliation":[{"name":"Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland"},{"name":"Centre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingvild","family":"Odsbu","sequence":"additional","affiliation":[{"name":"Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,11,2]]},"reference":[{"key":"2025073113115702000_7.1.e000759.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2018.02.023"},{"key":"2025073113115702000_7.1.e000759.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2013.11.003"},{"key":"2025073113115702000_7.1.e000759.3","doi-asserted-by":"crossref","unstructured":"Feghali MN , Scifres CM . Novel therapies for diabetes mellitus in pregnancy. BMJ 2018;362.doi:10.1136\/bmj.k2034","DOI":"10.1136\/bmj.k2034"},{"key":"2025073113115702000_7.1.e000759.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2007.02053.x"},{"key":"2025073113115702000_7.1.e000759.5","doi-asserted-by":"crossref","first-page":"325851","DOI":"10.1155\/2015\/325851","article-title":"Metformin treatment in type 2 diabetes in pregnancy: an active controlled, parallel-group, randomized, open label study in patients with type 2 diabetes in pregnancy","volume":"2015","author":"Ainuddin","year":"2015","journal-title":"J Diabetes Res"},{"key":"2025073113115702000_7.1.e000759.6","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.13481"},{"key":"2025073113115702000_7.1.e000759.7","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1177\/2042098618769831","article-title":"Metformin treatment of type 2 diabetes mellitus in pregnancy: update on safety and efficacy","volume":"9","author":"Polasek","year":"2018","journal-title":"Ther Adv Drug Saf"},{"key":"2025073113115702000_7.1.e000759.8","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-2350"},{"key":"2025073113115702000_7.1.e000759.9","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.1093\/humrep\/dey256","article-title":"Recommendations from the International evidence-based guideline for the assessment and management of polycystic ovary syndrome","volume":"33","author":"Teede","year":"2018","journal-title":"Hum Reprod"},{"key":"2025073113115702000_7.1.e000759.10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0064585","article-title":"Metformin vs insulin in the management of gestational diabetes: a meta-analysis","volume":"8","author":"Gui","year":"2013","journal-title":"PLoS One"},{"key":"2025073113115702000_7.1.e000759.11","doi-asserted-by":"crossref","DOI":"10.1136\/bmjdrc-2017-000456","article-title":"Metformin in gestational diabetes: the offspring follow-up (mig tofu): body composition and metabolic outcomes at 7-9 years of age","volume":"6","author":"Rowan","year":"2018","journal-title":"BMJ Open Diabetes Res Care"},{"key":"2025073113115702000_7.1.e000759.12","doi-asserted-by":"crossref","unstructured":"Brown J , Grzeskowiak L , Williamson K , et al . Insulin for the treatment of women with gestational diabetes. Cochrane Database Syst Rev 2017;11.doi:10.1002\/14651858.CD012037.pub2","DOI":"10.1002\/14651858.CD012037.pub2"},{"key":"2025073113115702000_7.1.e000759.13","doi-asserted-by":"crossref","first-page":"367.e1","DOI":"10.1016\/j.ajog.2018.06.013","article-title":"A cautionary response to SMFM statement: pharmacological treatment of gestational diabetes","volume":"219","author":"Barbour","year":"2018","journal-title":"Am J Obstet Gynecol"},{"key":"2025073113115702000_7.1.e000759.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-016-0954-4","article-title":"Metformin in women with type 2 diabetes in pregnancy (MiTy): a multi-center randomized controlled trial","volume":"16","author":"Feig","year":"2016","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025073113115702000_7.1.e000759.15","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1007\/s00125-017-4351-y","article-title":"Metformin use in pregnancy: promises and uncertainties","volume":"60","author":"Lindsay","year":"2017","journal-title":"Diabetologia"},{"key":"2025073113115702000_7.1.e000759.16","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0155737","article-title":"Prescribing of antidiabetic medicines before, during and after pregnancy: a study in seven European regions","volume":"11","author":"Charlton","year":"2016","journal-title":"PLoS One"},{"key":"2025073113115702000_7.1.e000759.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2008.03.001"},{"key":"2025073113115702000_7.1.e000759.18","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.8.1.S10"},{"key":"2025073113115702000_7.1.e000759.19","doi-asserted-by":"publisher","DOI":"10.1007\/BF00399936"},{"key":"2025073113115702000_7.1.e000759.20","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.mpmed.2014.09.007","article-title":"Epidemiology of diabetes","volume":"42","author":"Forouhi","year":"2014","journal-title":"Medicine"},{"key":"2025073113115702000_7.1.e000759.21","doi-asserted-by":"crossref","first-page":"489","DOI":"10.4239\/wjd.v8.i12.489","article-title":"Gestational diabetes from a to Z","volume":"8","author":"Mirghani Dirar","year":"2017","journal-title":"World J Diabetes"},{"key":"2025073113115702000_7.1.e000759.22","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318278ce86"},{"key":"2025073113115702000_7.1.e000759.23","doi-asserted-by":"publisher","DOI":"10.1530\/EC-18-0076"},{"key":"2025073113115702000_7.1.e000759.24","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1111\/aogs.13570","article-title":"Women's perceptions of medication use during pregnancy and breastfeeding-A Swedish cross-sectional questionnaire study","volume":"98","author":"Wolgast","year":"2019","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2025073113115702000_7.1.e000759.25","unstructured":"Statens Legemiddelverket (Norwegian Medicines Agency) . Refusjonslisten (Refund list), 2018. Available: https:\/\/legemiddelverket.no\/offentlig-finansiering\/refusjonslisten-refusjonssok [Accessed 07 Jan 2019]."},{"key":"2025073113115702000_7.1.e000759.26","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.amepre.2014.08.031","article-title":"Trends in pre-pregnancy diabetes among deliveries in 19 U.S. states, 2000-2010","volume":"48","author":"Bardenheier","year":"2015","journal-title":"Am J Prev Med"},{"key":"2025073113115702000_7.1.e000759.27","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.amepre.2015.01.026","article-title":"Trends in gestational diabetes among hospital deliveries in 19 U.S. states, 2000-2010","volume":"49","author":"Bardenheier","year":"2015","journal-title":"Am J Prev Med"},{"key":"2025073113115702000_7.1.e000759.28","doi-asserted-by":"crossref","DOI":"10.1136\/bmjdrc-2016-000221","article-title":"Trends in diabetes in pregnancy in Sweden 1998-2012","volume":"4","author":"Fadl","year":"2016","journal-title":"BMJ Open Diabetes Res Care"},{"key":"2025073113115702000_7.1.e000759.29","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.h102","article-title":"Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis","volume":"350","author":"Balsells","year":"2015","journal-title":"BMJ"},{"key":"2025073113115702000_7.1.e000759.30","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S113211"},{"key":"2025073113115702000_7.1.e000759.31","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000285"},{"key":"2025073113115702000_7.1.e000759.32","doi-asserted-by":"crossref","first-page":"782","DOI":"10.4239\/wjd.v6.i6.782","article-title":"Gestational diabetes mellitus: an update on the current international diagnostic criteria","volume":"6","author":"Agarwal","year":"2015","journal-title":"World J Diabetes"},{"key":"2025073113115702000_7.1.e000759.33","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.diabres.2017.04.018","article-title":"Adopting the new World Health organization diagnostic criteria for gestational diabetes: how the prevalence changes in a high-risk region in Australia","volume":"129","author":"Wong","year":"2017","journal-title":"Diabetes Res Clin Pract"},{"key":"2025073113115702000_7.1.e000759.34","unstructured":"Changing diagnostic criteria for gestational diabetes in Sweden (2018) welcome to the CDC4G study [Accessed 2019-04-30]."},{"key":"2025073113115702000_7.1.e000759.35","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1509819"},{"key":"2025073113115702000_7.1.e000759.36","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/S2213-8587(19)30002-6","article-title":"Use of metformin to treat pregnant women with polycystic ovary syndrome (PregMet2): a randomised, double-blind, placebo-controlled trial","volume":"7","author":"L\u00f8vvik","year":"2019","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2025073113115702000_7.1.e000759.37","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1007\/s13300-018-0479-0","article-title":"Long-Term effects of oral antidiabetic drugs during pregnancy on offspring: a systematic review and meta-analysis of follow-up studies of RCTs","volume":"9","author":"van Weelden","year":"2018","journal-title":"Diabetes Ther"},{"key":"2025073113115702000_7.1.e000759.38","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1210\/jc.2017-02419","article-title":"Metformin use in PCOS pregnancies increases the risk of offspring overweight at 4 years of age: follow-up of two RCTs","volume":"103","author":"Hanem","year":"2018","journal-title":"J Clin Endocrinol Metab"}],"container-title":["BMJ Open Diabetes Research &amp; Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjdrc-2019-000759","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T20:12:04Z","timestamp":1753992724000},"score":1,"resource":{"primary":{"URL":"https:\/\/drc.bmj.com\/lookup\/doi\/10.1136\/bmjdrc-2019-000759"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,11,2]]},"published-print":{"date-parts":[[2019,11]]}},"alternative-id":["10.1136\/bmjdrc-2019-000759"],"URL":"https:\/\/doi.org\/10.1136\/bmjdrc-2019-000759","relation":{},"ISSN":["2052-4897"],"issn-type":[{"value":"2052-4897","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11]]}}}