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Oral Drug May Control Pregnancy-Related Diabetes

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Oct. 18, 2000 -- Diabetes is the most common medical complication of pregnancy, occurring in 3% to 10% of all pregnancies. Some women who become diabetic during pregnancy need daily insulin injections, but a new study suggests that an oral drug called glyburide might free thousands of expectant mothers from the needle.

The study, published in The New England Journal of Medicine, reports that glyburide (marketed as DiaBeta, Micronase, or Glynase) can control so-called gestational diabetes. Further, study author Oded Langer, MD, noted no increase in birth defects in the babies of women who took glyburide while pregnant, compared with those born to women who took insulin. His study compared 201 women with pregnancy-related diabetes who took the oral drug with 203 who took insulin.

Gestational diabetes usually goes away after pregnancy. But if poorly controlled, it can affect the baby, leading to such difficulties at birth as large size (which can complicate delivery), low blood sugar, and breathing problems, and, later on, to an increased risk of obesity and diabetes, according to the American Diabetes Association. Some women are at particularly high risk for this type of diabetes. For example, the gestational diabetes rate is higher among Mexican-American and African-American women. Being overweight or older also increases the risk.

Most women who become diabetic during pregnancy try diet first to control their high blood sugar, but this doesn't always work. Doctors have rarely given other oral diabetes drugs to pregnant women because there has been concern about the drugs' possible effects on the baby before or shortly after birth.

But Langer reports that glyburide does not cross the placenta and so is unlikely to affect the fetus. He found that birth defects were rare in babies born to either group of women in his study, and that there was no difference in the rate of complications after delivery. Also, glyburide was less likely than insulin to "overdo" blood sugar control and cause the mother's blood sugar to go dangerously low. Langer is a professor and chair of obstetrics and gynecology at St. Luke's-Roosevelt Hospital Center in New York.

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