Insulin remains the gold standard pharmacological agent for glycaemic control in gestational diabetes mellitus primarily because it:

• A Does not cross the placenta ✓
• B Has no risk of maternal hypoglycaemia
• C Improves insulin sensitivity in peripheral tissues
• D Reduces the incidence of congenital malformations

Explanation

Insulin is a large peptide that cannot cross the placenta, so fetal exposure is avoided while maternal glucose falls, making it the reference standard in pregnancy. Maternal hypoglycaemia remains its principal adverse effect. Metformin and sulfonylureas cross the placenta, which is why metformin is regarded as second line despite comparable glycaemic outcomes in trials such as MiG.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.