A 33-year-old woman with gestational diabetes at 30 weeks has fasting glucose persistently above 110 mg/dL despite dietary therapy. She asks about oral therapy. Which agent is preferred by some centres partly because it crosses the placenta minimally compared with metformin?
- A Glyburide (glibenclamide) ✓
- B Pioglitazone
- C Glipizide
- D Sitagliptin
Correct answer: A. Glyburide (glibenclamide)
Explanation
Second-generation sulfonylureas cross the placenta poorly, and glyburide in particular shows negligible measurable transfer in perfused placenta studies, attributed to its high protein binding and ionization at fetal pH. Metformin freely crosses the placenta and reaches fetal therapeutic concentrations, though it remains widely used and considered safe. Pioglitazone and sitagliptin are not established options in pregnancy. Insulin still remains the gold standard when glycaemic targets are not met.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.