993: Adverse pregnancy outcomes with glyburide vs insulin among patients with gestational diabetes established by the International Association of Diabetes and Pregnancy Study Group (IADPSG)

Abstract

To address whether maternal use of glyburide is associated with greater incidence of adverse neonatal and maternal outcomes among patients with gestational diabetes mellitus (GDM) established by the International Association of Diabetes and Pregnancy Study Group (IADPSG) compared to insulin use. We prospectively followed a cohort of women with GDM, diagnosed with criteria established by IADPSG, who attended a High Risk Obstetrical Unit and Comprehensive Diabetic educational Program (Sweet Success). Initially all the patients were started on an American Diabetic Association diet and exercise program. Glyburide or insulin treatment was added if necessary to maintain fasting glucose and 1 hour postprandial glucose values of less than 90 mg per deciliter and 130 mg per deciliter respectively. During the study period, a total of 394 patients required glyburide or insulin treatment for control of the GDM. Among these patients, 171 of them were on glyburide while 223 of them were on insulin at time of delivery. Both the glyburide and insulin user groups have similar body mass index of >30 (30.17 + 7.43 versus 31.89 + 9.03) as well as rate of nulliparous patients (22.8 %versus 25.5%). Comparison of adverse neonatal and maternal outcomes between the 2 groups was shown in the table. Newborns of women treated with glyburide were not at increased risk for macrosomia (P = .077), hypoglycemia (P = .068), neonatal intensive care unit admission (P= 0.9291), fetal demise (P = 1.00), and preterm birth (P = 0.871), compared with those treated with insulin. There was also no difference in the incidence of preeclampsia/gestational hypertension (P = 0.2289) or primary cesarean delivery (P = 0.950) among the women treated with glyburide or insulin. Among patients with GDM diagnosed with criteria established by IADPSG, maternal glyburide use does not increase the incidence of macrosomia or hypoglycemia when compared with maternal insulin use. Overall pregnancies treated with glyburide are not at higher risk for adverse neonatal and maternal outcomes than those pregnancies treated with insulin.