Among newborns whose mothers were treated with a specific drug used to treat gestational diabetes, there was a higher risk of neonatal intensive care unit admission, respiratory distress, hypoglycemia (low blood glucose), birth injury and being large for gestational age compared with newborns of women treated with insulin.
The medication glyburide, which has been increasingly used to treat gestational diabetes in pregnant women, was associated with higher risk for newborns to be admitted to a neonatal intensive care unit, have respiratory distress, hypoglycemia (low blood glucose), birth injury and be large for gestational age compared with infants born to women treated with insulin, according to an article published online by JAMA Pediatrics.
The prevalence of gestational diabetes mellitus (GDM) in the United States has more than doubled during the last 20 years. Given the widespread and rapid use of glyburide in the last decade more evaluation of the comparative safety and effectiveness of the drug is needed. Previous literature on the association between treatment with glyburide and adverse neonatal outcomes is limited, according to background in the study.
Wendy Camelo Castillo, Ph.D., of the University of Maryland, Baltimore, and Michele Jonsson Funk, Ph.D., of the University of North Carolina at Chapel Hill, and coauthors estimated the risk of adverse maternal and neonatal outcomes in women with GDM treated with glyburide vs. insulin using data from a nationwide employer-based insurance claims database from 2000 through 2011. The authors 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), 35 percent higher risk of birth injury and 43 percent 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.
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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.
“Given the widespread use of glyburide, further investigation of these differences in pregnancy outcomes is a public health priority,” the study concludes.
Source: JAMA Pediatr. Published March 30, 2015. doi:10.1001/jamapediatrics.2015.74.
