Glyburide does not cross the placenta. Our original observations have been reconfirmed by several studies.Glyburide has been safely used in pregnancy without adverse effects on the fetus. In contrast, metformin, rosiglitazone, and pioglitazone freely cross the placenta.36–38 We await further evidence on safety when fetuses are exposed to these drugs. In the case of metformin with patients who have polycystic ovary syndrome, data from retrospective studies give us hope for its safe use. The ongoing Metformin in Gestational Diabetes study from Australia and New Zealand is evaluating in a randomized design the efficacy of metformin versus insulin use. Because there is no clinical study to date reporting on the use of thiazolidinediones in pregnancy, these agents should not be prescribed.
Glyburide is the most common oral agent used in GDM and is wholeheartedly endorsed by authoritative organizations. The drug increases insulin secretion and diminishes insulin resistance by lowering glucose toxicity. Its onset of action is ∼ 4 hours, and its duration of action is ∼ 10 hours. Thus, after achieving the targeted therapeutic level, glyburide covers the basal requirement as well as postprandial glucose excursions.
The starting dose is 2.5 mg orally in the morning. If the targeted level of glycemia is not attained, add 2.5 mg to the morning dose. If indicated (after 3–7 days), add 5 mg in the evening. Thereafter, increase the dose in 5-mg increments to a maximum of 20 mg/day. If the patient does not achieve targeted levels of glycemic control, add long-acting insulin to the regimen or assign the patient to insulin therapy alone.
Taken from >>American journal of obstetrics and gynecology<<
But in developing world, INSULIN IS THE MAIN STAY FOR TREATING DM in pregnant women or GDM.
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