In Pregnancy Issues and Concerns

Reprint of March 31, 2015 CBU blog post

WebMD reports on a study finding that glyburide, a treatment endorsed by ACOG, but not approved by the FDA for treating GDM, is associated with serious adverse newborn outcomes.

Using an insurance claims database, investigators isolated 9200 women with GDM, a population big enough to determine differences in uncommon outcomes, from women with Type 1 and Type 2 diabetes. Compared with women taking insulin, 30 more newborns per 1000 were admitted to neonatal intensive care and 11 more experienced respiratory distress. In addition, 6 more per 1000 experienced low blood sugar severe enough to require admission to intensive care, and 6 more per 1000 had birth injuries. The latter two statistics fell just short of achieving statistical significance, meaning unlikely to be due to chance; however, authors note that other studies have also found excess incidence of hypoglycemia in babies of mothers who took glyburide. Other studies have also shown increases in jaundice, although this study did not perhaps because jaundice had to be severe enough to require intensive care admission. An editorial on the study concludes: “The consistency of findings with previous studies raises cause for concern and the time has come to reconsider the place of glyburide in pregnancy.”

Glyburide vs. insulin aside, outcome statistics in both groups are appalling. Fully half the women in both groups had cesareans, and 9% of babies were born before 37 weeks, probably mostly because of inductions and planned cesareans. In contrast, a 1987 study in which midwives cared for GDM women reported a 9% cesarean rate in women completing prenatal care with the midwives despite one-quarter of them having babies weighing over 9 lbs (O’Brien 1987). Adding the women transferred to obstetric care still only raised the cesarean rate to 11%. Back in the day even studies of obstetrician-managed GDM reported cesarean rates in the 20 percents. I’ll grant that this is a higher risk population because blood sugar wasn’t controlled by diet, but 50% c-sections?

So, what do you think: Are the poor outcomes with GDM a result of GDM, or is this a case where the cure is worse than the disease?

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Reference

O’Brien ME, Gibson G. Detection and management of gestational diabetes in an out-of-hospital birth center. J Nurse-Midwifery 1987;32(2):79-84.

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