title: Pharmacokinetics, efficacy and safety of glyburide for treatment of gestational diabetes mellitus.
abstract: BACKGROUND
  Gestational diabetes mellitus (GDM) complicates 10% of all pregnancies and is defined as hyperglycemia first noted during pregnancy. Rates of GDM are rising and untreated GDM results in complications for both mother and fetus. GDM is often managed by diet and exercise but 30-40% of women will require pharmacological intervention. Insulin has traditionally been the treatment of choice but since 2007, glyburide, a second generation sulfonylurea has become the most prescribed medication for GDM.
  
  
  METHODS
  This review will cover the pharmacokinetics, efficacy, and safety of glyburide for the management of GDM.
  
  
  CONCLUSIONS
  Management of GDM is challenging secondary to the stringent glycemic goals that mimic the lower glucose levels in pregnancy. Glyburide is generally effective in treating hyperglycemia. However, several studies have raised safety concerns showing higher neonatal intensive care unit (NICU) admissions, higher rates of macrosomia, large for gestational age and pre-eclampsia in the mother. For this reason, insulin should be first-line therapy for GDM. In areas of limited resources where the self-monitoring needed for accurate insulin dosing is not possible, where access to refrigeration for insulin storage is not universal, or severe needle phobia then the benefits of glyburide (controlling hyperglycemia) outweighs the harm of NICU admissions and macrosomia.
authors.affiliation: a Department of Internal Medicine, Division of Endocrinology, Diabetes, and Nutrition , University of Maryland School of Medicine , Baltimore , MD , USA.
authors.forename: Rana
authors.initials: R
authors.lastname: Malek
authors.affiliation: b Department of Medicine, University of Maryland Medical Center , University of Maryland School of Medicine , Baltimore , MD , USA.
authors.forename: Stephen N
authors.initials: SN
authors.lastname: Davis
mesh_terms: D000818:Animals; D001786:Blood Glucose / Q000187:drug effects; D016640:Diabetes, Gestational / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005905:Glyburide / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D007231:Infant, Newborn; D007328:Insulin / Q000627:therapeutic use; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D011247:Pregnancy
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D005905:Glyburide
keywords: Efficacy; gestational diabetes mellitus; glyburide; pharmacokinetics; safety