Management of Gestational Diabetes

by Michael_Koger

Lifestyle change such as diet and exercise are necessary for management of gestational diabetes, and medication is effective as well.

The medical management of diabetes during pregnancy requires careful assessment of dietary modification as well as exercise. These measures facilitate control of the blood sugar. Moreover, physicians will prescribe either insulin or oral antidiabetic medication. There is controversy over which pharmacologic approach yields the best result [1, 2].

Many doctors believe that insulin is the drug of choice for women whose serum glucose is too high. An advantage of it over oral hypoglycemic drugs is that insulin does not cross the placenta. Oral agents, on the other hand, do cross the placenta; hence, their safety for the baby over a long period of time is not clear [1, 2].

Insulin versus Oral Agents

Specifically, metformin and glyburide have demonstrated benefit for the mother, but their safety for the offspring remains questionable.  Nevertheless, many physicians prefer the use of oral agents for women with gestational diabetes.  Guidelines for these issues vary, and some approaches suggest that insulin and oral medication are equal in their benefit for these patients [1, 2].

The recommendation in the United States has always been to use insulin as the first-line medication.  Many physicians, in fact, recommend the use of any form of that agent for these women [1, 2].

There is also the concern that the use of oral agents can lead to hypoglycemia in the newborn when the mother breastfeeds because the drug secretes in breast milk.  In these scenarios, it is important to closely monitor the baby’s blood sugar.  Moreover, physicians do recommend breastfeeding as it has many benefits for mother and child after the delivery [1, 2].

In reality, there is not much risk that mothers who take oral agents and breastfeed their babies will encounter a problem with hypoglycemia in the infant.  Also, many of these patients can discontinue their oral hypoglycemic medication after delivery [1].

Insulin Sensitivity Variation

At the same time, one must recognize that the woman’s sensitivity to insulin varies during pregnancy.    She becomes more resistant to it as pregnancy progresses, and this means that her risk of hypoglycemia during gestation declines since insulin is not as effective as it has been in the early stages of pregnancy [1, 2].  This is especially true of women with type 1 diabetes [2].

Consequently, she will need more insulin to remain in control during the second and third trimesters than in the first trimester [1, 2].  However, immediately after delivery, her sensitivity to it increases again, and it is likely that the doctor will have to decrease the amount she receives each day.


The management of gestational diabetes is complex, but a well-trained medical team can obtain a good clinical outcome for these women.


  1. Kelley, K., Carroll, D., and Meyer, A.  (2015).  A review of current treatment strategies for gestational diabetes mellitus.  Drugs in Context, 4, 212282.
  2. American Diabetes Association.  (2015).  Management of diabetes in pregnancy.  Section 12.  In Standards of Medical Care in Diabetes.  Diabetes Care, 38 (Suppl 1):  S77-S79.
  3. The photo shows a library at the U.S. Centers for Disease Control and Prevention and is reprinted with permission from that organization.


The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.

Updated: 09/03/2015, Michael_Koger
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