An editorial notes that the main limitation of this and other observational analyses is that the results may be affected by important confounding factors, but its author believes that the consistency of findings with previous studies raises cause for concern and the time has come to reconsider the place of glyburide in pregnancy. He considers viable alternatives to glyburide, noting that a number of small observational studies and clinical trials have suggested that metformin may be a better choice. He calls for resolution of concerns about the use of glyburide to treat gestational diabetes before this drug should be recommended for continued use in pregnancy.