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Featured Clinical Reviews

May 1, 2018

Insulin vs Glyburide for Gestational Diabetes

Author Affiliations
  • 1Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Jamestown, Rhode Island
  • 2Divisions of Endocrinology, Diabetes and Metabolism, and Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora
JAMA. 2018;319(17):1769-1770. doi:10.1001/jama.2018.4561

In 2017, gestational diabetes occurred in approximately 14% of pregnancies throughout the world, ranging from 9% in Africa to 12.6% in North America to 21% in Southeast Asia.1 Although there is not yet global agreement regarding diagnostic criteria for gestational diabetes, there is agreement on the complications of this disorder, including an increased risk of cesarean delivery and preeclampsia in mothers, macrosomia with possible birth injury and neonatal hypoglycemia and jaundice in infants, childhood obesity, and type 2 diabetes in both mothers and offspring.2 Maternal hyperglycemia, in addition to excess lipids and amino acids, causes nutrient excess and fetal hyperglycemia, which stimulates the fetal pancreas to secrete insulin, a potent growth factor resulting in fetal pancreas, heart, liver, and fat-store enlargement and changes in nutrient signaling pathways.3 Excess fetal insulin (hyperinsulinemia) may cause neonatal hypoglycemia and has been implicated in most of the problems affecting fetuses and infants.4,5

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