EFFECTS OF PREGNANCY ON THE PHARMACOKINETICS AND PHARMACODYNAMICS OF GLYBURIDE

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Gestational diabetes is the most common type of diabetes in pregnancy, complicating approximately 4% of all pregnancies in the United States. Tight glucose control with insulin reduces risks for the mothers and their babies, but can be associated with significant maternal hypoglycemia. The diagnosis and treatment of gestational diabetes is controversial. Treatment of hyperglycemia associated with gestational diabetes which has not responded to dietary treatment has conventionally been insulin. Challenges posed with patient education for insulin therapy, and patient acceptance with multiple insulin injections daily, often leads to lack of adherence that results in poor glycemic control. A recent study has reported that glyburide as compared to insulin for gestational diabetes resulted in similar improvements in blood glucose, large infants (associated birth injuries) and neonatal low blood sugar, with a decrease in maternal low blood sugar. Understanding the pharmacokinetic and pharmacodynamic changes of oral hypoglycemics during pregnancy is important because there is a narrow window of opportunity to achieve glycemic control. Pregnant women diagnosed with gestational diabetes and on a steady dose of glyburide will be studied between 28-38 weeks gestation. Blood and urine will be collected throughout the study day. If possible, additional blood samples will be collected during labor and delivery for measurement of glyburide concentration.