Can oral hypoglycemic agents be used for the treatment of gestational diabetes?
A. Although insulin remains the preferred initial treatment for women with gestational diabetes requiring medication for many, some experts have adopted glyburide for select women.8,9 Since gestational diabetes typically reflects an inadequate maternal response to increased insulin resistance in pregnancy, oral hypoglycemic agents may be an appropriate alternative to insulin therapy when gestational diabetes cannot be controlled by diet and activity alone. Because gestational diabetes is typically diagnosed after 20 weeks’ gestation, the risk for fetal malformation related to this treatment is low. Several trials of oral hypoglycemic-agent therapy have been conducted in women with gestational diabetes. In a randomized study, Langer et al found that glyburide was an effective alternative to insulin therapy and that its use was not associated with an increase in neonatal complications in women with gestational diabetes.10 Only 4% of mothers required conversion to insulin for failed oral
