SMFM Statement Pharmacological treatment of gestational diabetes

The purpose of this SMFM Statement is to review the available scientific literature regarding pharmacological treatment of GDM and to provide additional guidance to obstetric care providers regarding treatment of these women.  While this statement differs in some respects from the ACOG Practice Bulletin, the SMFM Publications Committee acknowledges that this difference is based on the values placed by different experts and providers on the evidence available in the medical literature and is not meant to represent an exclusive course of management. Given the available data, the SMFM Publications Committee concludes that in women with GDM in which hyperglycemia cannot adequately be controlled with medical nutrition therapy, metformin is a reasonable and safe first-line pharmacologic alternative to insulin, recognizing that one-half of women will still require insulin to achieve glycemic control.