PATTERNS AND TRENDS OF ANTIDIABETIC MEDICATION USE DURING PREGNANCY IN CHINA: A RETROSPECTIVE COHORT STUDY
Author(s)
Linfeng Jiang, BSc1, Yuqing Fan, BSc1, Nan Peng, PhD2, Ruolan Wei, BSc1, guoxian Lu, BSc1, Dongning Yao, PhD1;
1School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, China, 2School of Pharmaceutical Science and Technology,Tianjin University, Tianjin, China
1School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, China, 2School of Pharmaceutical Science and Technology,Tianjin University, Tianjin, China
OBJECTIVES: With the rising prevalence of diabetes in pregnancy (DIP) in China, the need for antidiabetic pharmacotherapy during pregnancy has increased. This study aimed to describe patterns and trends of antidiabetic medication use among pregnant women in China from 2019 to 2025.
METHODS: This retrospective cohort study used electronic medical records from a provincial medical insurance database in eastern China. Women aged 18-50 years with a singleton pregnancy lasting ≥20 weeks and at least one antidiabetic prescription between the last menstrual period and pregnancy end were included. Patients were classified as having pregestational diabetes mellitus (PGDM) or gestational diabetes mellitus (GDM) based on diabetes diagnosis or antidiabetic medication use before pregnancy. The index date was the first antidiabetic prescription during pregnancy. Follow-up continued until pregnancy end, death, loss to follow-up, or database closure. Descriptive analyses assessed initial and overall antidiabetic medication use during pregnancy, comparing PGDM and GDM patients.
RESULTS: A total of 46,101 DIP patients were included (6,292 PGDM and 39,809 GDM). The mean age at cohort entry was 32.1 years and mean gestational age was 28.0 weeks. Insulin was the most common initial therapy and increased over time (74.21% to 93.84%, p<0.001), whereas metformin initiation declined (24.67% to 5.99%, p<0.001). PGDM patients were more likely than GDM patients to initiate biguanides across all years (p<0.001), despite an overall decrease (p<0.001). Among PGDM patients, 37.73% switched antidiabetic classes from pre-pregnancy to pregnancy, most commonly from oral agents to insulin (68.01%). Overall, insulin predominated with an increasing trend (76.45% to 95.35%, p<0.001), while biguanide use was lower and declined over time (26.36% to 7.72%, p<0.001). Biguanide use remained higher in PGDM than GDM (p<0.001).
CONCLUSIONS: Despite guideline support for biguanides as alternative options for selected pregnant women, their real-world use in China remains conservative. Insulin continues to dominate antidiabetic treatment during pregnancy.
METHODS: This retrospective cohort study used electronic medical records from a provincial medical insurance database in eastern China. Women aged 18-50 years with a singleton pregnancy lasting ≥20 weeks and at least one antidiabetic prescription between the last menstrual period and pregnancy end were included. Patients were classified as having pregestational diabetes mellitus (PGDM) or gestational diabetes mellitus (GDM) based on diabetes diagnosis or antidiabetic medication use before pregnancy. The index date was the first antidiabetic prescription during pregnancy. Follow-up continued until pregnancy end, death, loss to follow-up, or database closure. Descriptive analyses assessed initial and overall antidiabetic medication use during pregnancy, comparing PGDM and GDM patients.
RESULTS: A total of 46,101 DIP patients were included (6,292 PGDM and 39,809 GDM). The mean age at cohort entry was 32.1 years and mean gestational age was 28.0 weeks. Insulin was the most common initial therapy and increased over time (74.21% to 93.84%, p<0.001), whereas metformin initiation declined (24.67% to 5.99%, p<0.001). PGDM patients were more likely than GDM patients to initiate biguanides across all years (p<0.001), despite an overall decrease (p<0.001). Among PGDM patients, 37.73% switched antidiabetic classes from pre-pregnancy to pregnancy, most commonly from oral agents to insulin (68.01%). Overall, insulin predominated with an increasing trend (76.45% to 95.35%, p<0.001), while biguanide use was lower and declined over time (26.36% to 7.72%, p<0.001). Biguanide use remained higher in PGDM than GDM (p<0.001).
CONCLUSIONS: Despite guideline support for biguanides as alternative options for selected pregnant women, their real-world use in China remains conservative. Insulin continues to dominate antidiabetic treatment during pregnancy.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
RWD4
Topic
Real World Data & Information Systems
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)