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| Glyburide and Pregnancy and Meformin and Pregnancy |
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There have been many radical changes for GDM treatment when diet and exercise alone fail. Prior to 2000, the vast majority of patients were instructed to start on insulin injections, sometimes four or five times per day. When added to fingerstick checks, that amounts to quite a bit of "poking" for a woman with GDM! Insulin was preferred because it is very effective and since your body naturally makes insulin, doctors felt comfortable it would not harm the developing baby. Luckily today our treatment of GDM involves significantly less bloodshed! This section focuses on research on glyburide and pregnancy, as well as the latest information on metformin and pregnancy.
In 2000, Dr. Langer published a series of over 400 patient he studied in the New England Journal of Medicine. This was the first major study looking at glyburide and pregnancy. He randomly assigned women with gestational diabetes between 11 and 33 weeks of pregnancy to traditional insulin versus glyburide. This study showed that a pill, glyburide, was not only effective in controlling maternal sugars, but is was also safe. The effectiveness of the treatment methods was similar between women on insulin or glyburide. Their baby outcomes were also similar. There were not increased rates of birth defects, and importantly the sizes of the babies were similar. Another important finding was that there was not glyburide in the cord blood (so baby's blood) in the pregnancies treated with glyburide. This means that very little, if any, glyburide is transported across the placenta. This is, of course, important for baby's safety.
There have been many new studies in the last several years that have confirmed Dr. Langer's original findings. At this time it is considered standard of care in patients that have mild to moderate levels of hyperglycemia to use glyburide as the treatment of choice. If patients have very high sugars, or severe hyperglycemia, chances are that those patients are going to need more medication than the maximum doses of glyburide allowed. Therefore insulin may still be used. One question currently being investigated is if glyburide is safe from conception through the first trimester. Otherwise all the research about glyburide and pregnancy appears reassuring.
Other methods of GDM treatment are also being explored. Metformin, also a pill, has been studied. This medication decreases the liver's production of sugar. It is a logical choice for medical management of GDM, because it is commonly used to treat infertility. Therefore women often conceive while using it. There have been many studies demonstrating it's safety in the first trimester, unlike glyburide. One initial small study looking at metformin had raised concerns over increased risk of blood pressure problems and fetal loss when metformin was used in pregnancy. However many other studies both before and after that study have reported great success with using metformin. Most recently, in the May 2008 issue of the New England Journal of Medicine, a study reporting success with this drug in pregnancy was published. In this study, 363 women received metformin and they had very similar outcomes when compared with women using insulin. They also noted no serious adverse events. Therefore, although trials continue, there is optimisim that metformin will provide an alternative treatment for pregnant women. Look for more information about this drug to come out in the next couple of years. Currently there is at least one large trial being performed.
Luckily for pregnant women with gestational diabetes, GDM treatment options are expanding. It is most important to achieve good control to optimize maternal and fetal outcomes of pregnancy. For lots more information on diabetes in pregnancy, see the link below.
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