In gestational diabetes mellitus, which pharmacological agent is preferred when glycaemic targets are not achieved by diet and lifestyle modification in a patient with eGFR 85 mL/min/1.73m², no cardiac history, at 26 weeks gestation?

• A Glibenclamide (glyburide)
• B Metformin
• C Acarbose
• D Insulin (short-acting analogue before meals, long-acting basal) ✓

Explanation

Insulin remains the gold-standard pharmacological treatment for GDM when diet alone fails, as it does not cross the placenta in significant amounts. Metformin is increasingly used as an alternative (MiG trial showed non-inferiority for primary outcomes), but ~46% of women still require supplemental insulin, and there are concerns about placental passage and long-term offspring metabolic effects. Glibenclamide (glyburide) is actively transported across the placenta and is associated with increased neonatal hypoglycaemia and macrosomia — no longer recommended by ACOG. Acarbose has limited evidence in pregnancy.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.