4.4.0.0 Phar­ma­co­log­ic Ther­a­py

4.4.1.0 Overview

Treat­ment of GDM with lifestyle and in­sulin has been demon­strat­ed to im­prove peri­na­tal out­comes in two large ran­dom­ized stud­ies as sum­ma­rized in a U.S. Pre­ven­tive Ser­vices Task Force re­view (40). In­sulin is the first-‍line agent rec­om­mend­ed for treat­ment of GDM in the U.S. While in­di­vid­u­al RCTs sup­port lim­it­ed efficacy of met­formin (41,42) and gly­buride (43) in re­duc­ing glu­cose lev­els for the treat­ment of GDM, these agents are not rec­om­mend­ed as first-‍line treat­ment for GDM be­cause they are known to cross the pla­cen­ta and data on safe­ty for off­spring is lack­ing (22). Fur­ther­more, in two RCTs, gly­buride and met­formin failed to pro­vide ad­e­quate glycemic con­trol in 23% and 25– 28%, re­spec­tive­ly (44,45), of women with GDM.