Reference no: EM133695561

Gestational diabetes mellitus: Glucose management and maternal prognosis What's New Early metformin treatment of gestational diabetes mellitus (November 2023) Usual initial gestational diabetes mellitus (GDM) care (ie, medical nutritional therapy, exercise) may result in a few weeks of hyperglycemia before a need for pharmacotherapy is established. In a randomized trial evaluating whether initiating metformin at the time of GDM diagnosis regardless of glycemic control improves clinical outcomes compared with usual care, the metformin group had a lower rate of insulin initiation and favorable trends in mean fasting glucose, gestational weight gain, and excessive fetal growth, but more births <2500 grams [1]. Rates of preeclampsia, neonatal intensive care unit admission, and neonatal hypoglycemia were similar for both groups. Given these mixed results, we recommend not initiating metformin at the time of GDM diagnosis except in a research setting. (See "Gestational diabetes mellitus: Glucose management and maternal prognosis", section on 'Does early metformin initiation improve glycemic control and reduce need for insulin?'.)

Treatment of gestational diabetes mellitus (GDM) can improve pregnancy outcome. Many patients can achieve glucose target levels with nutritional therapy and moderate exercise alone, but up to 30 percent will require pharmacotherapy [1]. Even patients with mildly elevated glucose levels.