From Standard of Care to Emerging Innovations: Navigating the Evolution of Pharmacological Treatment of Gestational Diabetes

Anna Palatnik; Maisa N. Feghali

doi:10.1055/a-2407-0905

American Journal of Perinatology, Table of Contents

Am J Perinatol 2025; 42(09): 1127-1134
DOI: 10.1055/a-2407-0905

Review Article

From Standard of Care to Emerging Innovations: Navigating the Evolution of Pharmacological Treatment of Gestational Diabetes

Anna Palatnik

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin

²Cardiovascular Center, Medical College of Wisconsin, Milwaukee, Wisconsin

,

Maisa N. Feghali

³Department of Obstetrics, Gynecology and Reproductive Sciences, Magee Women's Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

› Author Affiliations

Abstract

The incidence of gestational diabetes mellitus (GDM) continues to increase in the United States and globally. While the first-line treatment of GDM remains diet and exercise, 30% of patients with GDM will require pharmacotherapy. However, many controversies remain over the specific glycemic threshold values at which pharmacotherapy should be started, how intensified the therapy should be, and whether oral agents are effective in GDM and remain safe for long-term offspring health. This review will summarize recently completed and ongoing trials focused on GDM pharmacotherapy, including those examining different glycemic thresholds to initiate therapy and treatment intensity.

Key Points

The incidence of GDM continues to increase in the United States and globally.
While the first-line treatment of GDM remains diet, 30% of patients require pharmacotherapy.
Controversies remain over the specific glycemic threshold values at which pharmacotherapy is needed.
Another controversy is how tightly to control GDM.
Additional controversies are the safety of metformin and incretins in terms of offspring's long-term health.

Keywords

gestational diabetes - pharmacologic treatment - insulin - metformin - incretins

Full Text

References

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