Why is glyburide not considered the treatment of choice for gestational diabetes?

• A. Higher risk of preeclampsia
• B. Less effective
• C. Crosses placenta
• D. Risk of hypoglycemia

Answer: (A)

Glyburide isn’t the first-line treatment for gestational diabetes mainly because it can affect the fetus. This drug can cross the placenta and stimulate the fetal pancreas to release insulin. The resulting fetal hyperinsulinemia can lead to neonatal hypoglycemia after birth, and may be associated with higher birth weight. Insulin, by contrast, does not cross the placenta, allowing good maternal glucose control without exposing the fetus to the drug. So the key reason is placental transfer with potential fetal hypoglycemia, rather than a general increased risk of preeclampsia.