November 21, 2000
Question from USA:
I am thirty years old and have gestational diabetes for a second time. I am strictly following my diet, but it isn’t working this time. The nurse said that I need to go on insulin shots. I read somewhere on the Internet that the pills have been tested on pregnant women and are safe. Is this true? Which ones are safe ones to take?
There is a recent article in the New England Journal of Medicine (“A Comparison of Glyburide and Insulin in Women with Gestational Diabetes Mellitus.” Oded Langer, Deborah L. Conway, Michael D. Berkus, Elly M.-J. Xenakis, Olga Gonzales. Volume 343 October 19, 2000 Number 16) that compares glyburide with insulin in the treatment of gestational diabetes. The investigators report equally good control and no adverse effects on the fetus from the glyburide (i.e., glyburide does not appear to cross the placenta). About 200 women were in each arm of the study. This looks very promising, but I have not started to treat my patients in this manner. Discuss this with your doctor.
[Editor’s comment: The use of oral hypoglycemic medications during pregnancy, whether the mom has gestational, type�1 or type�2 diabetes, is “off-label.” That is to say, there are not sufficient scientific studies to verify if their use is both safe and effective. In pregnancy, safety issues for both mom and baby are paramount, and I’d be extremely reluctant to trust any single study. I’d advise you to use standard therapy (insulin) if any medications are needed. After all, it’s only for a few months in your case, and the outcome is way too precious to trust any single study.