Which statement about glyburide in gestational diabetes is true?

• A. Crosses placenta
• B. Does not cross placenta
• C. Is first-line therapy
• D. Associated with fetal hypoglycemia

Answer: (B)

Glyburide’s place in gestational diabetes hinges on how much of the drug reaches the fetus. The key concept is placental transfer and fetal exposure. Glyburide works by stimulating the mother’s pancreatic beta cells to release insulin, lowering her blood glucose. It has minimal placental transfer, so the fetus is exposed to little or no drug. Because of that limited fetal exposure, it is not commonly associated with fetal hypoglycemia from the drug itself.

That’s why the statement that it does not cross the placenta (or crosses minimally) is considered true. It’s not typically first-line therapy—insulin remains the standard initial pharmacologic option in many guidelines. The idea that the drug crosses the placenta would imply fetal exposure and potential fetal hypoglycemia, which isn’t supported by its minimal placental transfer.