Clinical Edge

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Guidelines for Gestational Diabetes Mellitus

Obstet Gynecol; ePub 2017 Jul; Caughey, et al

The American College of Obstetricians and Gynecologists (ACOG) has issued clinical management guidelines for the diagnosis and treatment of gestational diabetes mellitus (GDM) in pregnancy. The document provides a brief overview of the understanding of GDM, reviews management guidelines that have been validated by appropriately conducted clinical research, and identifies gaps in current knowledge. Among the recommendations offered:

Level A recommendations:

  • Women in whom GDM is diagnosed should receive nutrition and exercise counseling, and when this fails to adequately control glucose levels, medication should be used for maternal and fetal benefit.
  • When pharmacologic treatment of GDM is indicated, insulin is considered the first-line treatment for diabetes in pregnancy.

Level B recommendations:

  • All pregnant women should be screened for GDM with a laboratory-based screening test(s) using blood glucose levels.
  • In women who decline insulin therapy or for those women whom the obstetrician or obstetric care provider believes the patient will be unable to safely administer insulin, metformin is a reasonable second-line choice.
  • Glyburide treatment should not be recommended as a first-line pharmacologic treatment because, in most studies, it does not yield equivalent outcomes to insulin.
  • Health care providers should counsel women of the limitations in safety data when prescribing oral agents to women with GDM.
  • Women with GDM should be counseled regarding the risks and benefits of a scheduled cesarean delivery when the estimated fetal weight is 4,500 g or more.


Gestational diabetes mellitus. Practice Bulletin No. 180. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017;130:e17–31.