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pandora essence According to these results, glibenclamide should not be used for the treatment of women with gestational diabetes if insulin or metformin is available.Systematic review registration IntroductionGestational diabetes is a common complication of pregnancy, and prevalence is increasing.1 The standard therapy for women with gestational diabetes requiring drug treatment is insulin. However, since the seminal trial by Langer et al comparing glibenclamide (glyburide) with insulin,2 oral agents have been increasingly viewed as potential alternatives. For example, glibenclamide has been acknowledged in the Fifth International Workshop Conference in Gestational Diabetes Mellitus,7 and both glibenclamide and metformin are considered in National Institute for Health and Care Excellence (NICE) guidance8 and American College of Obstetricians and Gynecologists (ACOG) practice bulletin.9 Oral agents are an attractive alternative to insulin for their easier administration, lower cost, and better acceptance.10 Use of oral agents is increasing, and in some settings they are the first option when drug treatment is required for women with gestational diabetes.6 11 12 13 In a large nationwide retrospective cohort study in the US including 10778 women with drug treated gestational diabetes, use of glibenclamide increased from 7.4% in 2000 to 64.5% in 2011, becoming the most common treatment since 2007.12In recent years, several systematic reviews and meta analyses have summarized the published evidence using different approaches: combining randomized controlled trials and observational studies addressing glibenclamide,14 performing a meta analysis of randomized controlled trials comparing glibenclamide with insulin,15 combining randomized controlled trials addressing glibenclamide or metformin versus insulin in a single meta analysis,16 and conducting a meta analysis of randomized controlled trials comparing metformin with insulin.17 In 2013, the meta analysis by Gui and colleagues, which included five randomized controlled trials comparing metformin with insulin, showed differences favouring metformin in terms of maternal weight gain and pregnancy induced hypertension but favouring insulin in terms of gestational age at delivery and preterm birth.17 A later meta analysis addressing metformin versus insulin added a non randomized controlled trial study.18 In 2014, the meta analysis of Zeng and colleagues, including five randomized controlled trials comparing glibenclamide with insulin https://www.jewelleryn394a.top, showed differences favouring glibenclamide in terms of maternal hypoglycaemia but favouring insulin in terms of birth weight, macrosomia, and neonatal hypoglycaemia.15 As yet, randomized controlled trials comparing glibenclamide or metformin with insulin, or metformin with glibenclamide, have not been addressed in a comprehensive systematic review that evaluates the most relevant maternal and fetal outcomes.The aim of the present study was to compare risks and benefits of insulin, glibenclamide, and metformin in terms of short term outcomes when used for women with gestational diabetes requiring drug treatment pandora essence.