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ACOG Offers Guidance on Management of GDM

Obstet Gynecol; ePub 2018 Feb; ACOG, Turrentine

The American College of Obstetricians and Gynecologists (ACOG) has issued clinical management guidelines offering an update on the pharmacologic treatment of gestational diabetes mellitus (GDM). The practice bulletin reviews management guidelines that have been validated by clinical research and identifies gaps in current knowledge. Among the updated recommendations and conclusions from the ACOG:

  • When pharmacologic treatment of GDM is indicated, insulin is considered the preferred treatment for diabetes in pregnancy. (Level A)
  • In women who decline insulin therapy or who the obstetrician or other obstetric care providers believe will be unable to safely administer insulin, or for women who cannot afford insulin, metformin is a reasonable alternative choice. (Level B)
  • Glyburide treatment should not be recommended as a first-choice pharmacologic treatment because, in most studies, it does not yield equivalent outcomes to insulin. (Level B)
  • Women with GDM should be counseled regarding the risk and benefits of a scheduled cesarean delivery when the estimated fetal weight is ≥4,500 g. (Level C)


Gestational diabetes mellitus. ACOG Practice Bulletin No. 190. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2018;131:e49–64.