FINDINGS:

Women with gestational diabetes, controlled with diet, were randomized to receive placebo or glyburide. Primary outcome was a decrease in birth weight of 200g.  Secondary maternal outcomes included need for insulin and associated adverse outcomes such as chorioamnionitis, pregnancy-induced hypertension, need for operative delivery, shoulder dystocia and third and fourth degree perineal lacerations.  Secondary newborn outcomes included small for gestational age (SGA) and large for gestational age (LGA), as well as birth trauma, hypoglycemia, umbilical artery pH of less than or equal to 7 and high bilirubin.

• There was no difference in birthweight between the glyburide and placebo groups
• There was no difference in maternal adverse outcomes although the study was not adequately powered to detect differences in rare events such as shoulder dystocia
• There was no difference in adverse neonatal outcomes
• Diet therapy alone with regular glucose monitoring is the appropriate management plan for mild gestational diabetes

SYNOPSIS:

Diet control for the treatment of mild gestational diabetes is known to reduce birthweight and is the mainstay of therapy.  The authors, in a well-designed randomized controlled study, set out to determine if adding glyburide would further decrease birthweight which is associated with adverse outcomes such as birth trauma, shoulder dystocia and neonatal hypoglycemia (Obstet Gynecol 2015).  Women with mild gestational diabetes (fasting glucose below 105/mg/dL with at least 2 elevated values on the 3 hour glucose tolerance test) using the National Diabetes Data Group criteria were randomized into glyburide and placebo groups.  Even though this study demonstrated that glycemic profiles were significantly improved with the addition of glyburide, there was no additional benefit with the addition of glyburide to diet therapy.

KEY POINTS:

• Gestational diabetes is a common problem in pregnancy which can result in significant maternal and neonatal complications
• Diet therapy and glucose monitoring reduce the risk of LGA which is a cause of both maternal and newborn complications
• Maternal weight gain during pregnancy is an important risk factor for LGA

Learn More – Primary Sources:

Glyburide in Women With Mild Gestational Diabetes: A Randomized Controlled Trial

Related ObG Topics:

Gestational Diabetes Mellitus – Definitions, Risk Factors and Complications

What Is The ‘One-Step’ GDM Screening Approach?

Screening for Gestational Diabetes: The ‘2 Step’ Approach

GDM and Postpartum Followup – The ‘When and How’ of Screening

Levels of Evidence – How to Rate the Quality of a Study