A 30-year-old woman is diagnosed with GDM at 26 weeks by IADPSG criteria. At 28 weeks, despite medical nutrition therapy for 2 weeks, her fasting glucose is 96 mg/dL and 2-hour postprandial values are 128-138 mg/dL. She refuses insulin. What is an acceptable alternative?

• A Glibenclamide
• B Sitagliptin
• C Acarbose
• D Metformin ✓

Explanation

Metformin is an acceptable alternative to insulin in GDM when glycemic targets are not met with diet alone, particularly when patients refuse insulin. The MiG trial showed no increase in perinatal complications with metformin compared to insulin. Glibenclamide is no longer recommended as first-line due to higher rates of neonatal hypoglycemia and macrosomia. Acarbose and sitagliptin have insufficient safety data in pregnancy.

Reference: Williams Obstetrics, 25th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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