The effect of glyburide on pregnancy outcomes in morbidly obese women with gestational diabetes

Abstract

WOMEN WITH GESTATIONAL DIABETES JOSE DUNCAN, JERRIE REFUERZO, NATALIA CAMACHO, JYOTHI NICHANAMETLA, SEAN BLACKWELL, ROBERT SOKOL, YORAM SOROKIN, Wayne State University, Obstetrics and Gynecology, Detroit, Michigan, Wayne State University, Obstetrics & Gynecology, Detroit, Michigan, Wayne State University, Obstetrics/Gynecology, Detroit, Michigan, Wayne State University, Ob/Gyn/Maternal Fetal Med, Detroit, Michigan OBJECTIVE: Glyburide has been shown to be as effective as insulin for the treatment of gestational diabetes (GDM). The objective of this study is to determine whether glyburide results in similar delivery outcomes compared to insulin in morbidly obese women with GDM. STUDY DESIGN: A retrospective chart review was performed including women with GDM requiring medical therapy from January 2002 to December 2004. Women with multiple gestations and chromosomal/structural defects were excluded. Morbid obesity was defined as a body mass index (BMI) O 40 kg/m. Women were divided into morbidly obese and non-morbidly obese groups. Delivery outcomes were then compared between women on glyburide therapy versus insulin. RESULTS: There were 90 women who delivered with GDM requiring medical therapy, 28.9% (n=26) were morbidly obese and 71.1% (n=54) were not. Glyburide was given to 34.6% (n=9) of morbidly obese women and to 35.2% (n=19) of non-morbidly obese women. There was no difference between maternal age, race, gestational age at delivery, pre-eclampsia, rates of labor induction or smoking history between women treated with glyburide compared to insulin. In morbidly obese women, glyburide had similar rates of macrosomia (0% vs 23.5%, p=0.159) and cesarean section (55.6% vs. 35.3%, p=0.281) compared to insulin. In the non-morbidly obese women, glyburide significantly reduced the rates of macrosomia (0% vs. 22.9%, p=0.023) and cesarean section (10.4% vs. 51.4%, p=0.003). CONCLUSION: While glyburide has similar delivery outcomes compared to insulin in morbidly obese women with GDM, such therapy appears most effective in reducing the rates of macrosomia and cesarean section in women who are not morbidly obese.