Glyburide for Gestational Diabetes May Raise Babies' Risk for Complications

Although glyburide is commonly prescribed for gestational diabetes mellitus (GDM), the drug’s use among pregnant women may put newborns at greater risk for complications.

A recent study published online in JAMA Pediatrics examined data on 110,879 women with GDM from 2000 through 2011, excluding pregnant women with type 1 or 2 diabetes, as well as those aged <15 years and >45 years.

Of the GDM patients studied, 8.3% were treated with either glyburide (4982) or insulin (4191), and the proportion of the group that received glyburide increased from 8.5% in 2000 to 64.4% in 2011.

Compared with newborns of GDM patients treated with insulin, the offspring of glyburide-treated women had a:

• 41% higher risk of neonatal intensive care unit admission
• 63% higher risk of respiratory distress
• 40% higher risk of hypoglycemia
• 35% higher risk of birth injury, and
• 43% higher risk of being large for gestational age.

“Newborns from privately insured mothers treated with glyburide were more likely to experience adverse outcomes than those from mothers treated with insulin,” concluded the study authors. “Given the widespread use of glyburide, further investigation of these differences in pregnancy outcomes is a public health priority.”

On the bright side, the researchers discovered that GDM patients treated with glyburide were not at increased risk for obstetric trauma, preterm birth, or jaundice compared with those treated with insulin. Additionally, the risk of cesarean delivery was 3% lower among glyburide-treated women.

In an exclusive interview with Pharmacy Times, study co-authors Wendy Camelo Castillo, PhD, and Michele Jonsson Funk, PhD, noted that newborns of women with GDM are already more likely to experience complications, necessitating the use of a glucose control medication such as insulin or glyburide to minimize these risks.

While their research suggests that insulin reduces these risks more effectively than glyburide, factors such as cost and storage difficulty may make insulin a difficult option for some women, Drs. Camelo Castillo and Jonsson Funk pointed out. In such cases, glyburide use is still preferable to uncontrolled hyperglycemia or elevated blood glucose during pregnancy.

“The take-home message for health practitioners involved in the care of women with this condition is that more attention is needed in terms of identifying which patients are appropriate candidates for glyburide treatment,” Drs. Camelo Castillo and Jonsson Funk told Pharmacy Times. “The key to optimizing neonatal outcomes is adequate maternal glycemic control.”