Pharmacological Intervention: Insulin and Oral Agents
When lifestyle modifications (diet and exercise) fail to maintain blood glucose targets—typically defined as fasting <95 mg/dL and 1-hour post-prandial <140 mg/dL—pharmacological therapy is initiated.
Insulin remains the gold standard for GDM because it does not cross the placenta, ensuring maximum safety for the fetus. Treatment usually involves a combination of intermediate-acting NPH insulin and rapid-acting insulin analogs (like Lispro or Aspart). While oral agents like Metformin or Glyburide are sometimes used due to ease of administration, they do cross the placenta. Metformin, in particular, is often used in patients with significant insulin resistance, but insulin is preferred for its precision and lack of fetal exposure.
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