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The prevalence of gestational diabetes (GDM) is rising, yet optimal treatment strategies remain ill-defined. Although insulin has been the gold standard, oral agents — less expensive and generally better tolerated — are tempting. In a systematic review of randomized trials, outcomes were compared pairwise between insulin, metformin, and glyburide (known in Europe as glibenclamide).
Compared with insulin, glyburide was associated with more macrosomia (risk ratio, 2.6) and neonatal hypoglycemia (RR, 2.0). Compared with glyburide, metformin was associated with less maternal weight gain (mean difference, 2 kg) and less macrosomia (RR, 0.3). Against insulin, metformin was associated with less maternal weight gain (mean difference, 1 kg) and more …