Management of diabetes and pregnancy--when to start and what pharmacological agent to choose?

Gestational diabetes mellitus (GDM) complicates 3-15% of pregnancies depending upon the geographic location and ethnic groups, and its incidence is estimated to increase even further due to the increasing rates of obesity in the general population and the trend towards advanced maternal age in pregnancy. GDM is associated with adverse pregnancy outcome such as an increased rate of fetal macrosomia, neonatal metabolic disturbances, and maternal injuries. It has been shown that there is an inverse relation between maternal glycemic control and the risk of complications. When diet and exercise therapy fail in achieving good glycemic control, pharmacological intervention is warranted. This chapter deals with the evidence regarding the various pharmacological interventions for glycemic control in women with GDM, when to start, and what pharmacological agent to use.