The prevalence of gestational diabetes mellitus (GDM) in the U.S. has more than doubled during the last 20 years, which has increased the use of the medication glyburide to treat GDM in pregnant women.
[Photo: UNC researchers found that newborns whose mothers were treated for gestational diabetes mellitus with glyburide rather than insulin were at much higher risk of respiratory distress, hypoglycemia, birth injury and admission to a neonatal intensive care unit. Photo by Richard Anderson]
However, a new study co-authored by researchers at The University of North Carolina at Chapel Hill’s Gillings School of Global Public Health has found that glyburide is associated with higher risk for newborns to be admitted to a neonatal intensive care unit and present with respiratory distress, hypoglycemia (low blood glucose), or birth injury compared with infants born to women treated with insulin.
The article, co-authored by Dr. Michele Jonsson Funk, research associate professor of epidemiology at the Gillings School, is titled “Glyburide vs Insulin in Association With Adverse Pregnancy Outcomes in Women With Gestational Diabetes,” and was published online March 30 by JAMA Pediatrics.
Dr. Jonsson Funk and her co-authors estimated the risk of adverse maternal and neonatal outcomes in women with GDM treated with glyburide versus insulin using data from a nationwide employer-based insurance claims database.
The authors examined data from the years 2000 through 2011 and excluded women with Type 1 or 2 diabetes, as well as those younger than 15 and older than 45.
Among 110,879 women with GDM, 9,173 women (8.3 percent) were treated with glyburide (4,982 women) or insulin (4,191 women). Use of glyburide rose and the proportion of the group treated with glyburide increased from 8.5 percent in 2000 to 64.4 percent in 2011.
The authors found that among newborns whose mothers were treated with glyburide, there was a 41 percent higher risk of neonatal intensive care unit admission, 63 percent higher risk of respiratory distress, 40 percent higher risk of hypoglycemia (low blood glucose) and 35 percent higher risk of birth injury. In addition, 43 percent showed a higher risk of being large for gestational age compared with newborns of women treated with insulin.
The difference in risk per 100 women associated with glyburide compared with insulin was 2.97 percent for neonatal intensive care unit admission, 1.41 percent for large for gestational age and 1.1 percent for respiratory distress.
Women treated with glyburide, as compared with insulin, were not at increased risk for obstetric trauma, preterm birth or jaundice. The risk of cesarean delivery was 3 percent lower in the glyburide group, according to the results.
“Glyburide is available in pill form, whereas insulin has to be injected,” said Dr. Jonsson Funk. “The convenience factor makes glyburide an attractive option for women with gestational diabetes. In light of these findings, I believe we need to better understand which patients can be managed effectively with this drug.”
Co-author Dr. Wendy Camelo Castillo was a doctoral student in the Gillings School’s department of epidemiology at the time of the study.