Background Offspring born to mothers with gestational diabetes mellitus (GDM) are more likely to have negative neurodevelopmental health outcomes, early obesity, type 2 diabetes, and metabolic syndrome in childhood, adolescence, and adulthood. Standard of care management for GDM and type 2 diabetes mellitus during pregnancy is insulin, but oral sulfonylurea use is increasing, and these medications cross the placenta. Literature on treatment with sulfonylureas for maternal GDM has focused on maternal glycemic control and neonatal outcomes. Studies that have evaluated the long‐term outcomes of children exposed to sulfonylureas in utero are limited. Objective This study evaluated anthropometric and neurodevelopmental outcomes of 55 children (ages 5–10) born to mothers with diabetes during pregnancy treated with sulfonylurea or insulin. Methods and Results A group of 25 sulfonylurea‐exposed and 30 insulin‐exposed participants were age‐ and sex‐matched between groups. No significant differences were identified in z‐scores for body mass index (BMI), waist circumference, skinfold measurements, and body fat or rates of overweight/obese BMI between groups. On performance‐based cognitive assessment, the sulfonylurea‐exposed group had significantly lower scores on inhibition (p = 0.043). Conclusion In summary, children with in utero sulfonylurea exposure had similar physical measurements compared to children with insulin exposure and lower performance on a measure of executive function (inhibition), which is associated with adverse health outcomes.

Outcome data in children exposed to glyburide for maternal treatment of gestational diabetes mellitus (GDM) is lacking. Insulin is the standard of care for GDM medical management, yet glyburide use is increasing and this medication crosses the placenta. The study objective was to evaluate physical and neurodevelopmental outcomes of 5-10 year old children born to GDM mothers treated with glyburide or insulin. Children had anthropometric measures including body composition with air displacement plethysmography, and underwent a neurodevelopmental assessment with performance-based tests to evaluate executive functions of working memory and inhibition. Analysis included paired t-tests, chi-square test, and multivariate analysis of variance (MANOVA). Participants, n=51, 25 glyburide-exposed, 26 insulin-exposed were age and sex-matched between groups. Mean age was 7.7 years and 45% were female. Ethnicity and maternal education differed between groups: glyburide-exposed were primarily Hispanic (80%) and had lower maternal education level compared to insulin-exposed (50% Hispanic). Anthropometric means were: BMI 18.8 kg/m2 (sd 5.1), BMI%ile 67.7% (32.3), waist circumference z-score 0.6 (1.1), body fat 21.9% (11.6), triceps z-score 0.8 (1.2), subscapular z-score 1.1 (1.1), sum of 3 skinfolds, triceps, subscapular, iliac crest 39.3 mm (26.0), systolic bp 101 (10.1), diastolic bp 63 (8.2). Among participants, 17.6% had an overweight BMI and 23.5% had an obese BMI. No significant differences were identified in these measures or rates of overweight/obese BMI between groups. A MANOVA with maternal education as a covariate showed that the glyburide-exposed group had significantly lower scores on a visual-spatial working memory test compared to the insulin-exposed group (p=0.03). No differences were observed on an inhibition test. In summary, children with intrauterine glyburide exposure had reduced spatial working memory yet similar physical measurements compared to children with insulin exposure. Disclosure M.S. Rodenstein: None. M.E. Bianco: None. M. Ramchal: None. R.L. Silton: None. M. Murias: None. J.L. Josefson: None. Funding Evergreen Invitational and Institute for Innovations in Developmental Sciences