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eonatal adiposity following maternal treatment of gestationaliabetes with glyburide compared with insulin

ristine Y. Lain, MD, MS; Matthew J. Garabedian, MD, MPH; Ashi Daftary, MD; Arun Jeyabalan, MD, MS

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BJECTIVE: We hypothesized that body composition would be similarmong neonates of women with gestational diabetes (GDM) treatedith glyburide or insulin.

TUDY DESIGN: Women with GDM requiring medical therapy were ran-omized to insulin or glyburide. The primary outcome was percent neona-

al fat mass measured by total body electrical conductivity. Secondary out-omes included anthropometrics, glycemic control, and biomarkers.tatistical analysis included Student t test, �2, and regression modeling.

ESULTS: Eighty-two neonates underwent postnatal measurements.

nsulin. Am J Obstet Gynecol 2009;200:501.e1-501.e6.

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oi: 10.1016/j.ajog.2009.02.038

ass did not differ between treatment groups (11.2 � 4.2 vs 12.85.7). Fat mass, body mass index, ponderal index, skinfold sum,

nd arm fat area were not different when analyzed by intent to treatr actual treatment group. Cord concentrations of biomarkers werelso similar.

ONCLUSION: There was no difference in neonatal adiposity in infantsf women treated for GDM with glyburide or insulin.

ey words: fetal fat mass, gestational diabetes, glyburide,
aseline factors were not different by group. Neonatal percent fat randomized clinical trial, treatment
ite this article as: Lain KY, Garabedian M, Daftary A, et al. Neonatal adiposity following maternal treatment of gestational diabetes with glyburide compared to

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estational diabetes affects 3-10% ofpregnancies, and the incidence

ontinues to rise with the rising rates ofbesity. Although screening and diag-ostic thresholds remain controversial,

reatment may improve outcomes. Theustralasian Carbohydrate Intolerance

rom the Departments of Obstetrics andynecology (Drs Lain and Garabedian) andedicine (Dr Lain), University of Kentucky

ollege of Medicine, Lexington, KY, andagee-Womens Research Institute and theepartment of Obstetrics, Gynecology, andeproductive Sciences, University ofittsburgh School of Medicine, Pittsburgh,A (Drs Daftary and Jeyabalan).

resented at the 29th Annual Meeting of theociety for Maternal-Fetal Medicine, Saniego, CA, Jan. 26-31, 2009

eceived Nov. 22, 2008; revised Feb. 3, 2009;ccepted Feb. 26, 2009.

eprints: Kristine Y. Lain, MD MS, Departmentf Obstetrics and Gynecology, University ofentucky, 800 Rose St, Room C365,exington, KY 40536-0293.

his work was supported by Grants from themerican Association of Obstetricians andynecologists Foundation and Magee-omens Health Foundation (both to K.Y.L.).

002-9378/$36.002009 Published by Mosby, Inc.

tudy in Pregnancy demonstrated a 67%ower risk for a serious perinatal out-ome with intervention.1

The primary goal of therapy is euglyce-ia. Treatment modalities begin with diet

nd exercise, but approximately 50% ofomen require medication. Insulin isost commonly used, but oral hypoglyce-ic agents are increasingly chosen. Several

tudies that compared insulin with gly-uride demonstrated similar efficacy inchieving glycemic control.2-6 Other stud-es analyzed factors related to glyburidereatment success.7-9

Neonatal outcomes after glyburide areimilar to insulin.2,3 Neonatal measuresf fetal size (birthweight, large for gesta-ional age, and macrosomia) are mostommonly reported, but few studiesave reported a measure of fetal bodyomposition or serum markers of me-abolism. Neonatal body composition

ore precisely reflects the individual ef-ects of the maternal environment andxposures on fetal growth and better es-imates fetal effects of various methodsf maternal glycemic control. This ran-omized clinical trial was designed toompare neonatal body compositionnd metabolic markers at birth inomen with gestational diabetes treated

glyburide. n

MAY 2009 Americ

ATERIALS AND METHODS

his study was conducted at Magee-omens Hospital (University of Pitts-

urgh, Pittsburgh, PA) from 2002 to005. Institutional review board ap-roval and written informed consentere obtained prior to enrollment. Preg-ant women were screened using a 50 g,

hour oral glucose tolerance testOGTT) followed by a 100 g, 3 hourGTT for screens greater than 135 mg/L. Two abnormal values (95, 180, 155,nd 140 mg/dL), an elevated fastingalue on 3 h OGTT, or 1 h OGTT greaterhan 200 mg/dL was diagnostic.10 Pa-ients received education with the diabe-es care team including dietary andlood sugar monitoring (fasting and 2our postprandial value) instructions.edical therapy was recommended if

lood sugars exceeded goals of 95 (fast-ng) or 120 mg/dL (2 hour postprandialalue).Inclusion criteria also included 24-34eeks’ gestational age, a singleton preg-ancy, no known fetal anomalies or in-

rauterine growth retardation, and nose of other medications with knownlycemic effect. Subjects were random-zed using a random permuted block de-ign (block sizes of 4) and sequentially
umbered, opaque, sealed envelopes.
an Journal of Obstetrics & Gynecology 501.e1

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5

he research team performing the neo-atal measurements was masked toroup assignment. Assays were per-ormed in a blinded fashion.

The diabetes care team provided med-cation instructions and therapy goalsfasting � 95 mg/dL and 2 hour post-randial value � 120 mg/dL). Insulinas dosed at 0.8 U/kg in multiple daily

njections with long-acting and short-cting insulin and increased up to twiceeekly. Glyburide was started at 2.5 mg/ay, increased in 2.5-5 mg incrementseekly, and taken once or twice daily.omen were transitioned to insulin-

nly therapy if the maximum dose of gly-uride (20 mg/day) did not achieveoals. Medication timing was adjusted to

FIGURERandomization and patient follow-

ICU, neonatal intensive care unit; TOBEC, total body electricalain. Neonatal adiposity after maternal treatment of GDM w

he patient’s schedule. p

01.e2 American Journal of Obstetrics & Gynecolo

Routine obstetric care, including tim-ng and mode of delivery, was providedy the patient’s primary clinic. Testingecommendations included fetal kickounts, twice-weekly nonstress tests,nd ultrasonographic growth assess-ents in the third trimester. A maternal

onfasting sample for hemoglobin A1cHgbA1c) and biomarkers was collectedt enrollment and presentation for deliv-ry. Glycemic control was assessedourly during active labor and glucoseoncentrations greater than 105 mg/dLere treated with insulin.Gestational age was determined byenstrual history and ultrasound data.ord blood was collected at delivery. Neo-atal glucose was assessed per newborn

uctivity.lyburide. Am J Obstet Gynecol 2009.

rotocol. Early feeding was encouraged. t

gy MAY 2009

Neonatal measurements were per-ormed within 36 hours of life and wereone in triplicate. Infants were weighed ondigital scale. Length was measured to theearest 0.2 cm using an infant O’Leary

ength board. Head, chest, abdominal,high, and midarm circumferences were

easured to the nearest millimeter with alastic tape using standard referenceoints. Triceps, subscapular, suprailiac,nd anterior thigh skinfold thicknessesere measured with Lange skinfold cali-ers using standard procedures.11

Body composition was measured withpediatric total body electrical conduc-

ivity (TOBEC) HP-2 instrument (EM-can, Springfield, IL). Complete descrip-ions of total body electric conductivitynstruments, theory, and validationtudies are described elsewhere.12,13

riefly, TOBEC utilizes an electromag-etic field generated by passing a low-

requency oscillating electrical currenthrough a solenoid coil trough.13 Anybject placed in the field dissipates a por-ion of the field’s energy and changes im-edance. The magnitude of the imped-nce change is a function of the magneticeld properties and the object’sonductivity.13

Fat-free mass (FFM) contains electro-ytes and is more conductive than fat

ass (FM). The subject is clothed andrapped in a blanket to ensure no con-

act between extremities and trunk thatould alter body geometry. A computer-enerated estimate of FFM was calcu-ated from the disruption of the electro-

agnetic field, and the mean of 10easurements over a period of time less

han 5 minutes was used. FM was calcu-ated by subtraction of FFM from thetudy weight. Precision and reproduc-bility of TOBEC methodology were val-dated in neonatal piglets by carcass anal-sis and in human infants using 18O-abeled water.12,14,15 The coefficient ofariation of TOBEC is less than 2%term infants) and less than 5% (pretermnfants). Measurements were performedy 1 of 2 examiners.Infant birthweights were comparedith institutional-derived standards

tratified by race and sex.16 Birthweightlassifications included large for gesta-

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www.AJOG.org Obstetrics Research

ge (� 10%), macrosomia (� 4000 g),nd low birthweight (� 2500 g). Calcu-ated anthropometric measures includ-d: (1) Ponderal index (PI; weight/ength3); (2) body mass index (BMI;eight/length2); (3) skinfold sum (sumf 4 skinfold thickness measurements);nd (4) arm fat area (difference in armrea [arm circumference2/4�] and armuscle area ([arm circumference –*triceps skinfold]2/4�).Plasma was prepared from blood anti-

oagulated with ethylenediaminetetra-cetic acid. Samples were stored at -80°Cor biomarker analysis. Measurementsere done in duplicate. C-peptide and

nsulin were assayed with radioimmuno-ssay kits from Diagnostic Productsorp (Los Angeles, CA). Glucose was as-

ayed using a diagnostic kit from Sigmahemical Co (St Louis, MO). Total adi-onectin measurements were performedith a radioimmunoassay kit fromINCO Research, Inc (St Charles, MO).The primary outcome was percent FM

s measured by TOBEC. Secondary out-omes included FFM, FM, anthropo-etric measurements, birthweight, neo-

atal complications, and cord bloodiomarkers. Other secondary outcomes

ncluded glycemic control (fasting and 2our postprandial blood sugars), obstet-ic outcomes, and maternal and neonataliomarkers (c-peptide, glucose, insulin,nd adiponectin).

Statistical analysis included Student test, �2, and regression modeling. Multi-ariable models included gestational aget delivery, maternal race, maternal age,nd infant sex as potential confoundingariables. Analysis was performed asoth intent to treat and actual therapyeceived using SPSS 16.0 for Windowstatistical software (1989-2007; SPSS Inc,hicago, IL). Power calculations for

quivalency between glyburide and insu-in were performed. Equivalency calcu-ations use the expected difference in the

groups (0 in this study) and the widthround the expected means that woulde accepted as equal (�). Tolerance is ex-ressed as the percentage change fromhe expected value. Using an expected

ean percent FM of 12.8% and toler-nce of 20%, we estimated that the inclu-
ion of 40 women in each group would
rovide 80% power with � � 0.5. A tol-rance of 15% would require 80 patientser group.

ESULTSf 99 subjects randomized, 50 were as-

igned to insulin and 49 to glyburideFigure). Eighty-two neonates under-ent postnatal measurements. Seventy-ne of the 82 neonates had TOBEC per-ormed. Ninety percent of the womenere diagnosed on the basis of theGTT. The remainder were diagnosed

y the 1 hour OGTT or persistently ele-ated finger stick blood sugar readings.

TABLE 1Baseline characteristics of random

Insuli

Maternal age (y) 31.2...................................................................................................................

Gestational age at enrollment (wks) 30.6...................................................................................................................

Race (black) (%) 8 (1...................................................................................................................

Nulliparity (%) 19 (4...................................................................................................................

Primigravid (%) 12 (2...................................................................................................................

Glucola (50 g) 170.9...................................................................................................................

OGTT..........................................................................................................

Fasting (mg/dL) 101.5..........................................................................................................

1 hour (mg/dL) 203.4..........................................................................................................

2 hour (mg/dL) 173.1..........................................................................................................

3 hour (mg/dL) 122.2...................................................................................................................

BMI (kg/m2) 30.9...................................................................................................................

HgbA1c (%) 5.0...................................................................................................................

BMI, body mass index; HgbA1c, hemoglobin A1c; OGTT, orData are presented as mean � SD unless otherwise indicateLain. Neonatal adiposity after maternal treatment of GDM

TABLE 2Measures of glycemic control by tr

Insulin

Blood glucose (mg/dL)..........................................................................................................

Fasting 90.9..........................................................................................................

Postprandial breakfast 106 �..........................................................................................................

Postprandial lunch 109.3..........................................................................................................

Postprandial dinner 115.7...................................................................................................................

Maximum dose glyburide (mg/day)...................................................................................................................

Maximum dose insulin (U/day) 51.3...................................................................................................................

Data are presented as mean � SD.
Lain. Neonatal adiposity after maternal treatment of GDM wi
MAY 2009 Americ

The 2 groups had similar demograph-cs at entry (Table 1). Gestational age atandomization, 1 hour OGTT results, 3our OGTT results, and startinggbA1c were also not different by

roup.Measures of glucose control are listed

n Table 2. For each patient, fasting andostprandial blood sugars were averageduring drug administration. Postpran-ial dinner glucoses were increased inhe glyburide group. The mean totalaily insulin was 51 � 33 U/day andoses ranged from 10 to 126 U/day. Theean glyburide dose was 8 � 7 mg/day

d patients by treatment group� 41) Glyburide (n � 41) P value

5.9 32.2 � 5.0 .39..................................................................................................................

2.2 30.8 � 2.5 .61..................................................................................................................

) 3 (7.3) .19..................................................................................................................

) 13 (31.7) .26..................................................................................................................

) 8 (19.5) .44..................................................................................................................

27.8 166.7 � 23.3 .48..................................................................................................................

..................................................................................................................

12.4 100.9 � 15.9 .86..................................................................................................................

26.0 199.7 � 28.6 .56..................................................................................................................

34.9 176.9 � 35.9 .66..................................................................................................................

33.8 119.3 � 35.0 .73..................................................................................................................

5.7 33.4 � 12.9 .42..................................................................................................................

0.5 5.0 � 0.5 .89..................................................................................................................

cose tolerance test.

th glyburide. Am J Obstet Gynecol 2009.

tment group� 41) Glyburide (n � 41) P value

..................................................................................................................

.0 90.4 � 21.8 .89..................................................................................................................

.0 109.8 � 20.4 .33..................................................................................................................

6.8 110.5 � 18.3 .75..................................................................................................................

.7 124.8 � 23.6 .03..................................................................................................................

8 � 6.7..................................................................................................................

3.4..................................................................................................................

izen (n

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501.e4 American Journal of Obstetrics & Gynecology MAY 2009

nd ranged from 1.25 to 20 mg/day. Ofhe 41 women randomized to glyburide,ral therapy was not successful in 3 whoere transitioned to insulin.The primary outcome, percent fatass, is listed with other TOBEC and an-

hropometric measurements in Table 3.eight recorded at birth was higher in

he glyburide group, but study weightsere not different. When analyzed by ac-

ual therapy and adjusted for potentialonfounding variables (gestational age atelivery, maternal race, maternal age,nd infant sex), the birthweight differ-nce between the 2 groups was 119 g andas not significant (P � .3). Chest cir-

umference differences also did not per-ist when evaluated by actual therapy re-eived. Measures of adiposity were notifferent when analyzed by intent to treatr actual treatment group.Macrosomia occurred in 10 subjects, 9

rom the glyburide group and 1 from thensulin group. One patient from the gly-uride group was transitioned to insulin.hen measures of glucose control were

ompared between those patients withnd without macrosomia, there was noifference in mean fasting and postpran-ial blood sugars. The maximum gly-uride dose was also not different.Preterm delivery occurred in 17.5%

nd 16.7% for the insulin and glyburideroups, respectively. There were no oc-urrences of fetal distress, maternalrauma, or placental abruption. Thereas one intrauterine fetal demise in thelyburide group and was complicated byrisomy 21. Shoulder dystocia compli-ated 2 deliveries in the insulin groupnd 1 delivery in the glyburide group.here were no neonatal deaths, nerve in-

uries, bone fractures, or neonatal hem-rrhage in either group. Overall, 11 neo-ates were admitted to the neonatal

ntensive care unit (5 insulin and 6 gly-uride). Three of the 4 neonates with hy-oglycemia required intravenous ther-py and all from the glyburide grouporal therapy was not successful in 1).here were no infants with sepsis, sei-ures, or pulmonary hypertension.

Metabolic biomarkers are listed in Ta-le 4. Glucose at presentation for deliv-ry was different in the 2 groups, and this

TABLE 3Neonatal measures of growth by treatment groupNeonatal anthropometrics Insulin (n � 41) Glyburide (n � 41) P value

Percent fat massa 11.2 � 4.2 12.8 � 5.7 .18..............................................................................................................................................................................................................................................

Fat massa 370.1 � 166.7 473.3 � 278.4 .06..............................................................................................................................................................................................................................................

Fat-free massa 2876.6 � 289.9 3021.1 � 363.9 .07..............................................................................................................................................................................................................................................

Gestational age at delivery 38.2 � 1.1 38.5 � 1.2 .40..............................................................................................................................................................................................................................................

Infant sex (%) .82.....................................................................................................................................................................................................................................

Male 21 (55.3) 24 (58.5).....................................................................................................................................................................................................................................

Female 17 (44.7) 17 (41.5)..............................................................................................................................................................................................................................................

BIRTH MEASUREMENTS

Weight (g) 3363.2 � 385.0 3603.7 � 607.0 .04.....................................................................................................................................................................................................................................

Length (cm) 50.7 � 2.2 51.3 � 2.6 .25.....................................................................................................................................................................................................................................

Head circumference (cm) 34.3 � 1.3 34.7 � 1.8 .21.....................................................................................................................................................................................................................................

BMI (weight/length2) 13.1 � 1.5 13.6 � 1.7 .14.....................................................................................................................................................................................................................................

PI (weight/length3) 25.9 � 3.7 26.6 � 3.3 .40..............................................................................................................................................................................................................................................

STUDY MEASUREMENTS

Weight (g) 3277 � 386.6 3482.8 � 591.2 .07.....................................................................................................................................................................................................................................

Length (cm) 49.4 � 2.0 50 � 2.2 .18.....................................................................................................................................................................................................................................

BMI (weight/length2) 13.4 � 1.1 13.8 � 1.6 .15.....................................................................................................................................................................................................................................

PI (weight/length3) 27.2 � 2.2 27.7 � 2.8 .40..............................................................................................................................................................................................................................................

EXTREMITY LENGTH (cm)

Shoulder-elbow 10.7 � 0.5 10.7 � 0.7 .89.....................................................................................................................................................................................................................................

Hip-knee 11 � 0.6 11.2 � 0.7 .37..............................................................................................................................................................................................................................................

CIRCUMFERENCES (cm)

Head 33.9 � 1.3 34.2 � 1.5 .43.....................................................................................................................................................................................................................................

Chest 32.0 � 1.3 32.8 � 2.0 .05.....................................................................................................................................................................................................................................

Abdominal 31.9 � 1.5 32.8 � 2.4 .07.....................................................................................................................................................................................................................................

Upper leg 15 � 1.4 15.5 � 1.6 .18.....................................................................................................................................................................................................................................

Upper arm 10.6 � 0.8 10.8 � 1.1 .45..............................................................................................................................................................................................................................................

SKINFOLD (mm)

Triceps 3.9 � 0.7 3.9 � 0.9 .89.....................................................................................................................................................................................................................................

Subscapular 4.1 � 1.0 4.5 � 1.3 .10.....................................................................................................................................................................................................................................

Suprailiac 2.1 � 0.6 2.1 � 0.6 .85.....................................................................................................................................................................................................................................

Thigh 5.1 � 1.2 5.4 � 1.7 .28..............................................................................................................................................................................................................................................

Skin fold sum 15.2 � 3.0 16 � 4.0 .29..............................................................................................................................................................................................................................................

Arm fat area 8.6 � 1.4 8.8 � 1.8 .48..............................................................................................................................................................................................................................................

WEIGHT FOR GESTATIONAL AGE (%)

� 10% 0 2 (4.9) .01.....................................................................................................................................................................................................................................

10-90% 35 (92.1) 27 (65.9).....................................................................................................................................................................................................................................

� 90% 3 (7.9) 12 (29.3)..............................................................................................................................................................................................................................................

Macrosomia (� 4000 g) (%) 1 (2.4) 9 (22) .01..............................................................................................................................................................................................................................................

Low birthweight (%) 0 2 (4.9) .49..............................................................................................................................................................................................................................................

BMI, body mass index; PI, ponderal index.Data are presented as mean � SD unless otherwise indicated.a Total body electrical conductivity measurements were obtained on 35 neonates in the insulin group and 36 in the glyburide

group.

ifference remained when analyzed by

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ctual therapy received. Cord c-peptideas associated with birthweight (P �

01) and neonatal BMI (P � .03), percentat mass (P � .01), fat mass (P � .001),kinfold sum (P � .03), and arm fat areaP � .03). Maximum glyburide dose butot the insulin dose was associated withord adiponectin (P � .04).

OMMENTmong women with gestational diabe-

es, neonatal body composition was sim-lar for those treated with glyburide ornsulin. Measures of metabolic control,ord metabolic biomarkers, and obstet-ic outcomes were also similar. These re-ults corroborate other studies showingimilar results between the 2 medica-ions for glucose control and neonatalutcomes.GDM shares neonatal risks, including

etal overgrowth, with type 1 and type 2iabetes.17,18 Treatment results in de-reased perinatal complications.1 Be-ause obese infants are at risk for obesitynd glucose intolerance as children anddults, the etiology, detection, and man-gement of fetal overgrowth has receivedreat attention. As in adults, body mass in-ex, ponderal index, and anthropometriceasurements at birth are better thaneight alone as estimates of fetal obesityut are unable to distinguish different in-rauterine metabolic environments.

Our study is unique in primary out-ome and inclusion of biomarkers. Fatass and body composition are mea-

ured safely, rapidly, precisely, and non-nvasively using TOBEC.19-22 TOBEC

ethodology is based on the predomi-ant distribution of electrolytes in hy-rated lean tissue and extracellular waterather than in adipose tissue23 and pro-ides greater precision in the identifica-ion of fetuses with altered growth. Pre-ious studies demonstrated increasedeonatal fat mass in offspring of diabet-

cs compared with controls, but TOBECas not been used in treatment trials ofDM.19,22

Prospective and retrospective studiesuggest glyburide is effective in control-ing maternal blood sugars.2-4 A recent

etaanalysis evaluated growth using
ata from 9 studies with a total of 1382 m
ubjects.24 The study found no differ-nce in macrosomia, birthweight, andarge for gestational age.24 Only 1 studyas prospective and randomized.2 Our

rial adds to the neonatal growth datand includes more specific measures ofeonatal body composition.Pirc et al25 reported increased glucose

nd reduced adiponectin in women withntreated mild GDM compared withontrols and increased adiponectinith treatment. We included metaboliciomarkers to evaluate the influence ofreatment on the adipoinsulin axis.hanges in the neonatal markers would

eflect the intrauterine environment andould suggest possible long-term conse-uences. Our results do not suggest dif-erences in the adipoinsulin axis withlyburide compared with insulin.Limitations of this study included

ower-than-expected recruitment. Therial was stopped early secondary to dis-ontinuation of maintenance of equip-

TABLE 4Metabolic biomarkers by treatmenBiomarker Insulin

Insulin (U/mL)..........................................................................................................

Maternal enrollmenta 28.6 �..........................................................................................................

Maternal deliveryb 21.5 �..........................................................................................................

Cordc 10.6 �...................................................................................................................

C-peptide (ng/mL)..........................................................................................................

Maternal enrollment 6.0 �..........................................................................................................

Maternal delivery 4.5 �..........................................................................................................

Cord 1.6 �...................................................................................................................

Glucose (mg/dL)..........................................................................................................



Cord 75.6 �...................................................................................................................

Insulin to glucose ratio cord 0.2 �...................................................................................................................

Adiponectin (ng/mL)..........................................................................................................



Cord 32.7 �...................................................................................................................

Data are presented as mean � SD.a Maternal enrollment samples included 28 in the insulin gr

included 38 in the insulin group and 31 in the glyburide grthe glyburide group.

Lain. Neonatal adiposity after maternal treatment of GDM

ent used to obtain the primary out- t

MAY 2009 Americ

ome. Also, patients and providers werencreasingly interested in utilizing gly-uride first-line and declined random-

zation. As a result, our tolerance is largerhan expected. Our observed difference,owever, is much smaller than expectedt 1.6%, so it is doubtful that larger num-ers would have yielded different results.second limitation is the involvement ofultiple providers resulting in treat-ent bias. Although recommendations

o referring physicians were standard-zed, timing of delivery, induction, and

ode of delivery varied. Finally, subtleifferences in glycemic control may haveontributed to the few differences ob-erved between glyburide and insulin.ontrol with glyburide is likely to im-rove as provider experience with oralypoglycemic agents is gained.The use of glyburide during pregnancy

as potential advantages including de-reased cost, ease of administration,ewer side effects, and patient satisfac-

oupGlyburide P value

..................................................................................................................

.5 24.2 � 41.1 .63..................................................................................................................

.0 17.6 � 23.9 .44..................................................................................................................

.6 8.2 � 7.6 .48..................................................................................................................

..................................................................................................................

5.0 � 4.1 .32..................................................................................................................

5.1 � 4.3 .52..................................................................................................................

1.8 � 1.1 .54..................................................................................................................

..................................................................................................................

.6 74.3 � 21.7 .28..................................................................................................................

.6 71.7 � 22.8 .03..................................................................................................................

.9 63.5 � 20.6 .09..................................................................................................................

0.2 � 0.2 .72..................................................................................................................

..................................................................................................................

6.6 � 4.1 .67..................................................................................................................

7.1 � 4.6 .55..................................................................................................................

.0 31.4 � 23.3 .82..................................................................................................................

and 31 in the glyburide group; b Maternal delivery samplesc Cord samples included 28 in the insulin group and 31 in


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ial. Glyburide is effective for achievinglycemic control2-4 and safe by measuresf obstetric and neonatal outcomes.24

etal growth/obesity and metabolic ef-ects, however, remain a primary concern.

ore data from larger randomized clinicalrials is necessary to compare less commoneonatal outcomes. This study does pro-ide important data regarding neonatalody composition and metabolic markershat add to the available neonatal outcomend safety information. f

CKNOWLEDGMENTSe thank Linda Gooch, RN, Dawn Solerno, RN,awal Cuddy, RD CDE, Mary Ann Babjak, RNDE, and Stacy McGonigal for their invaluablessistance and support. In addition, we thankhe other staff and physicians of the diabetesare team at Magee-Womens Hospital (Pitts-urgh, PA).

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