0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

Glyburide vs Insulin and Adverse Pregnancy Outcomes

Shadi Rezai, MD1; Monica Vielman, MD1; Cassandra E. Henderson, MD1,2
[+] Author Affiliations
1Lincoln Medical and Mental Health Center, Bronx, New York
2New York Weill Cornell Medical Center, New York
JAMA Pediatr. 2015;169(10):974-975. doi:10.1001/jamapediatrics.2015.1808.
Text Size: A A A
Published online

Extract

To the Editor We were prompted by the increasing prevalence of gestational diabetes and widespread obstetric use of oral sulfonylureas to read with interest the retrospective analyses by Camelo Castillo et al.1,2 From an employer-based insurance database, Camelo Castillo and colleagues confirmed reports of others that infants born to women treated with glyburide are at increased risk for being large for gestation age and having hypoglycemia, both potential markers of fetal and neonatal hyperinsulemia.3 The authors also found these infants exposed to glyburide during the fetal period were at increased risk for birth injury. While the relationship between large for gestation age and birth injury is clearly understandable, the authors did not address the confounding health care professional variability in the glyburide group as it relates to obstetric surgical intervention and lower cesarean and episiotomy rates. The decision to perform a cesarean is often not based on objective evidence, but driven primarily by the health care professional’s own experience or anecdotal data.4 A health care professional may consider the use of insulin rather than glyburide as a marker for disease severity and, therefore, an indication for cesarean delivery. During the study period, 2000 to 2011, health care professionals in the United States chose to perform fewer episiotomies; once again, we suggest this invokes the variable of health care professional choice affecting the outcome of interest, birth injury.5 While we agree with the authors that use of glyburide during pregnancy may be problematic, the higher rates of birth injury associated with glyburide may not be directly related to this hypoglycemic agent, but rather caused by patterns of obstetric surgical intervention during the study period.

Topics

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

October 1, 2015
Wendy Camelo Castillo, MD, PhD; Michele Jonsson Funk, PhD
1Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore
2Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
JAMA Pediatr. 2015;169(10):975. doi:10.1001/jamapediatrics.2015.1811.
CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

175 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Jobs
brightcove.createExperiences();