title: Treatment of gestational diabetes mellitus: glyburide compared to subcutaneous insulin therapy and associated perinatal outcomes.
abstract: OBJECTIVE
  To examine perinatal outcomes in women with gestational diabetes mellitus treated with glyburide compared to insulin injections.
  
  
  METHODS
  This is a retrospective cohort study of women diagnosed with gestational diabetes mellitus (GDM) who required pharmaceutical therapy and were enrolled in the Sweet Success California Diabetes and Pregnancy Program between 2001 and 2004, a California state-wide program. Women managed with glyburide were compared to women treated with insulin injections. Perinatal outcomes were compared using chi-square test and multivariable logistic regression models; statistical significance was indicated by p < 0.05 and 95% confidence intervals (CI).
  
  
  RESULTS
  Among the 10,682 women with GDM who required medical therapy and met study criteria, 2073 (19.4%) received glyburide and 8609 (80.6%) received subcutaneous insulin injections. Compared to insulin therapy and controlling for confounders, oral hypoglycemic treatment was associated with increased risk of birthweight >4000 g (aOR = 1.29; 95% CI [1.03-1.64]), and admission to the intensive care nursery (aOR = 1.46 [1.07-2.00]).
  
  
  CONCLUSIONS
  Neonates born to women with gestational diabetes managed on glyburide, and were more likely to be macrosomic and to be admitted to the intensive care unit compared to those treated with insulin injections. These findings should be examined in a large, prospective trial.
authors.affiliation: Department of Obstetrics, University of California, San Francisco, CA, USA. yvecheng@hotmail.com
authors.forename: Yvonne W
authors.initials: YW
authors.lastname: Cheng
authors.forename: Judith H
authors.initials: JH
authors.lastname: Chung
authors.forename: Ingrid
authors.initials: I
authors.lastname: Block-Kurbisch
authors.forename: Maribeth
authors.initials: M
authors.lastname: Inturrisi
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D005905:Glyburide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000209:etiology; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D005905:Glyburide