Despite treatment, HbA1c ≥ 37 mmol/mol in the first trimester is associated with premature delivery among South Asian women with gestational diabetes mellitus: a retrospective cohort study.

PURPOSE: To examine the effects of first-trimester HbA1c (HbA1c-FT) ≥ 37 mmol/mol on preterm birth (PTB) and large-for-gestational-age (LGA) babies in a retrospective cohort of South Asian pregnant women with gestational diabetes (GDM). METHODS: The cohort (n = 686) was separated into two groups based on HbA1c-FT values: Group A (n = 97) and Group B (n = 589), with values of 37-46 mmol/mol (5.5-6.4%) and < 37 mmol/mol (5.5%), respectively. HbA1c-FT's independent influence on PTB and LGA babies was examined using multivariable logistic regression in groups A and B women. The reference group (Group C) included 2031 non-GDM women with HbA1c-FT < 37 mmol/mol (< 5.5%). The effects of HbA1c-FT on PTB and LGA babies in obese women in Groups A, B, and C (designated as A-ob, B-ob, and C-ob, respectively) were re-analyzed using multivariable logistic regression. RESULTS: Group A GDM women with greater HbA1c-FT had a higher risk for PTB (aOR:1.86, 95% CI:1.10-3.14) but not LGA babies (aOR:1.13, 95%: 0.70-1.83). The risk of PTB was higher for obese women in Group A-ob: aOR 3.28 [95% CI 1.68-6.39]. However, GDM women with normal HbA1c-FT exhibited no elevated risk for PTB: Groups B and B-ob had aORs of 1.30 (95% CI 0.86-1.98) and 1.28 (95% CI 0.88-1.85) respectively. CONCLUSIONS: South Asian GDM women with prediabetic HbA1c FT; 37-46 mmol/mol (5.5-6.4%) are more likely to deliver preterm babies despite treatment, while the risk for LGA babies was the same as non-GDM women.

Gestational diabetes mellitus in early pregnancy amongst Asian Indian women: Evidence for poor pregnancy outcomes despite treatment.

AIM: To compare the pregnancy outcomes in women with gestational diabetes (GDM) based on the timing of diagnosis. METHODS: This retrospective cohort study was conducted between January 2011 and September 2017 amongst 2638 Asian Indian pregnant women. The inclusion criteria included; singleton pregnancies having HbA1c <48 mmols/mol (6.5%) in the first trimester, GDM screening by 75 g OGTT using IADPSG criteria and delivery at our centre. The cohort was divided into 3 groups: Early GDM (E-GDM)-diagnosis <24 gestational weeks (Gw), Standard GDM (S-GDM)-diagnosis ≥24Gw, Non-GDM- No GDM ≥24 Gw. Multivariable logistic regression models compared the pregnancy outcomes between Non-GDM, S-GDM and E-GDM groups. A sub-group multivariable analysis was done amongst GDM women using gestational age at diagnosis both as a categorical and continuous variable. RESULTS: Compared to Non-GDM women, the odds were higher for premature birth, large for gestational age (LGA) babies, macrosomia, Neonatal ICU(NICU) admission and lower for normal vaginal delivery in the E-GDM group, but for the S-GDM group, the risk was higher for premature birth, LGA babies, NICU admission and induction of labour. Compared to GDM women in the 24-28 Gw category significantly higher odds for premature birth and LGA babies were observed in the <14 Gw category. A continuous increase of 19% odds for premature birth with every 4 weeks decrease in gestational age at GDM diagnosis was observed. CONCLUSIONS: Asian Indian women having a GDM diagnosis before 24Gw are at higher risk for adverse pregnancy events than those having diagnosis ≥24Gw or not having GDM.

Intermediate hyperglycemia in early pregnancy: A South Asian perspective.

"Intermediate hyperglycemia in early pregnancy (IHEP)" refers to mild hyperglycemia detected before 24 gestational weeks (GW), satisfying the criteria for the diagnosis of gestational diabetes mellitus. Many professional bodies recommend routine screening for "overt diabetes" in early pregnancy, which identifies a significant number of women with mild hyperglycemia of undetermined significance. A literature search revealed that one-third of GDM women in South Asian countries are diagnosed before the conventional screening period of 24 GW to 28 GW; hence, they belong in the IHEP category. Most hospitals in this region diagnose IHEP by oral glucose tolerance test (OGTT) using the same criteria used for GDM diagnosis after 24 GW. There is some evidence to suggest that South Asian women with IHEP are more prone to adverse pregnancy events than women with a diagnosis of GDM after 24 GW, but this observation needs to be proven by randomized control trials. Fasting plasma glucose is a reliable screening test for GDM that can obviate the need for OGTT for GDM diagnosis among 50% of South Asian pregnant women. HbA1c in the first trimester predicts GDM in later pregnancy, but it is not a reliable test for IHEP diagnosis. There is evidence to suggest that HbA1c in the first trimester is an independent risk factor for several adverse pregnancy events. Further research to identify the patho-genetic mechanisms behind the fetal and maternal effects of IHEP is strongly recommended.

Establishing Trimester-Specific Haemoglobin A1c Reference Intervals in Pregnant Women: A retrospective study of healthy South Asian women with normal pregnancy outcomes.

Objectives: This study aimed to define trimester-specific haemoglobin A1c (HbA1c) reference intervals in healthy, pregnant South Asian women. Methods: This retrospective study was conducted at St. Stephen's Hospital, Delhi, India, between January 2011 and December 2016. Healthy pregnant women were compared to a control group of healthy non-pregnant women. Pregnant participants had term deliveries of babies with appropriate gestational weights. The HbA1c levels were calculated in terms of non-parametric 2.5 and 97.5 percentiles for women in first (T1), second (T2) and third (T3) trimester groups. Statistical tests were used to obtain the normal HbA1c reference values and were considered significant when P <0.05. Results: This study included a total of 1,357 healthy pregnant women and a control group of 67 healthy, non-pregnant women. Pregnant women had a median HbA1c of 4.8% (4-5.5%) or 32 mmol/mol (20-39 mmol/mol); non-pregnant women had a median HbA1c of 5.1% (4-5.7%) or 29 mmol/mol (20-37 mmol/mol; P <0.001). The HbA1c levels for the T1, T2 and T3 groups were 4.9% (4.1-5.5%) or 30 mmol/mol (21-37 mmol/mol), 4.8% (4.5-5.3%) or 29 mmol/mol (20-34 mmol/mol) and 4.8% (3.9-5.6%) or 29 mmol/mol (19-38 mmol/mol), respectively. The HbA1c values were significant when comparing T1 versus T2 (P <0.001), T1 versus T3 (P = 0.002) and T1 versus the non-pregnant group (P = 0.001). However, T2 versus T3 was not significant (P = 0.111). Conclusion: Compared to non-pregnant women, HbA1c levels were lower in pregnant women, despite women in the T2 and T3 groups having a higher body mass index than the women in the T1 and non-pregnant groups. Further research is recommended to understand the factors responsible and validate these findings.

Is HbA1c in the first trimester associated with adverse outcomes among pregnant Asian Indian women without gestational diabetes?

AIMS: The aim of this study is to determine the association of elevated HbA1c in the first trimester (HbA1c-FT) with adverse events among pregnant Asian Indian women without gestational diabetes (GDM). METHODS: This retrospective cohort study included 1618 pregnant women who delivered at a single urban tertiary care center and had HbA1c-FT estimation between January 2011 and September 2017. Those with GDM according to a 75-g OGTT after 24 gestational weeks were excluded. Multivariable logistic regression models assessed the association between elevated HbA1c-FT and adverse events. RESULTS: At a cutoff of ≥37 mmol/mol (5.5%), HbA1c-FT was associated with preterm birth at <37 gestational weeks (adjusted odds ratio (OR) 2.10, 95% CI 1.11-3.98). There was a continuum of risk for primary caesarean delivery with higher HbA1c-FT levels (adjusted OR per 5-mmol/mol (0.5%) increase in HbA1c-FT for primary caesarean delivery: 1.27, 95% CI 1.06-1.52). In the crude analysis, gestational hypertension was associated with HbA1c-FT, but not after adjustment for confounding factors. HbA1c-FT was not associated with other adverse events (macrosomia, large for gestational age babies, or other neonatal complications). CONCLUSIONS: Even without GDM, the results suggest an association of HbA1c-FT with preterm birth and primary caesarian delivery among Asian Indian women.

Prevalence of 'Hyperglycemia in pregnancy' remained stable between 2006 and 2015, despite rise in conventional risk factors: A hospital based study in Delhi, North India.

AIMS: Between 2006 and 2015, the trends in prevalence of Hyperglycemia in pregnancy (HIP); Gestational diabetes (GDM), Diabetes in Pregnancy (DIP), Pre existing diabetes (PDM) and GDM risk factors were studied in 30,692 pregnancies among Asian Indian women. METHODS: GDM (n = 4089) and DIP (n = 259) diagnoses were by 75 g OGTT, while PDM (n = 103) was identified by ICD code O24. Women with DIP and PDM were grouped together as pre-gestational diabetes (PGDM n = 362). Crude and age-adjusted prevalence trend analysis by Poisson and Jointpoint regression models respectively, were done in GDM and PGDM groups. RESULTS: During study years, the GDM prevalence by WHO 1999 and modified IADPSG criteria, showed decreasing and static trends respectively, while PGDM prevalence remained static. In a subgroup of 2560 women, mean BMI increased from 24.12 ± 4.16 in year 2011 to 25.18 ± 4.7 Kg/m2 in 2015 (p < 0.014), but this rise had no impact on GDM prevalence. GDM risk factors; maternal age, gravidity ≥3, previous GDM and abortion, high income, diabetes and hypertension in family, were higher in 2011-2015 than in 2006-2010 period. On multivariate analysis, BMI was not an independent GDM risk factor. CONCLUSION: Despite rise in conventional GDM risk factors, HIP prevalence was static for a decade among pregnant Asian Indian women.

Glycated haemoglobin in the first trimester: A predictor of gestational diabetes mellitus in pregnant Asian Indian women.

AIM: To assess the efficacy of first trimester glycated hemoglobin (HbA1c-FT) in diagnosing or predicting gestational diabetes mellitus (GDM) in Asian Indian women. METHODS: This retrospective cohort study involved 2275 women who underwent both HbA1c-FT estimation and GDM screening with a one-step 75 g oral glucose tolerance test. Receiver Operating Characteristic (ROC) curve statistics were applied to assess the discriminative ability of HbA1c-FT in GDM diagnosis. A multivariable logistic regression analysis after adjusting for plausible confounders was used to evaluate the independent effect of HbA1c-FT on GDM diagnosis. RESULTS: The mean HbA1c-FT of GDM (n = 578) and non-GDM women (n = 1697) were 5.04 + 0.04% and 4.9 + 0.37%, respectively (p < 0.001). Compared to women with a HbA1c-FT < 5.2%, the adjusted odds ratio to develop GDM of women with an HbA1c-FT range of 5.2-5.5% and those >5.6% to develop GDM were 1.627 (p < 0.004) and 2.6 (p < 0.001), respectively. The area under the ROC curve to detect GDM was 0.606 (95% CI: 0.519-0.633 p < 0.001), but the sensitivity and specificity of the HbA1c-FT were not sufficient to diagnose, rule in or rule out GDM. CONCLUSIONS: HbA1c-FT is an independent GDM predictor in Asian Indian women but lacks sufficient sensitivity or specificity for use as a diagnostic test.

Bimodal distribution of fasting, one and two hour post load plasma glucose in Asian Indian pregnant women without pre-gestational diabetes: Gestational age related changes.

•After exclusion of pre-gestational diabetes, Asian Indian pregnant women have bimodal distribution of plasma glucose.•Bimodality is observed for fasting, 1 and 2 h post glucose load plasma glucose distribution.•Cut off values for gestational diabetes diagnosis could not identified for any glucose parameter.•In women with high gestational diabetes risk factors, the bimodality is evident before 24 weeks of gestation.•By third trimester, the bimodality is significant for all glucose parameters.

Gestational Diabetes Mellitus: Using the Fasting Plasma Glucose Level to Simplify the International Association of Diabetes and Pregnancy Study Groups Diagnostic Algorithm in an Adult South Asian Population.

OBJECTIVES: To evaluate the value of the fasting plasma glucose (FPG) level for simplifying the International Association of Diabetes and Pregnancy Study Groups (IADPSG) diagnostic algorithm of gestational diabetes mellitus (GDM) in a South Asian population. METHODS: In 6,520 pregnant women undergoing universal screening with the 75 g oral glucose tolerance test (OGTT), the area under receiver operating characteristic curve was used to determine the overall FPG performance to detect GDM (IADPSG criteria). Specifically, 2 different FPG thresholds of the OGTT were used to rule in and rule out GDM so as to decrease the need for the cumbersome OGTT. RESULTS: GDM was present in 1,193 (18.3%) women. The FPG 1) area under receiver operating characteristic curve (95% CI) was 0.909 (0.898 to 0.920); 2) threshold of ≥5.1 mmol/L independently could rule in GDM in 708 (10.9%) women (100% specificity); 3) threshold of <4.3 mmol/L independently could rule out GDM in an additional 2,389 (36.6%) women (95.6% sensitivity). CONCLUSIONS: By circumventing nearly one half the OGTTs, an initial FPG can simplify the onerous GDM diagnostic IADPSG algorithm in this population parochially and in countries with large South Asian immigrant populations-without compromising medical care.

Bimodal glucose distribution in Asian Indian pregnant women: Relevance in gestational diabetes mellitus diagnosis.

AIMS: Presence of bimodality in plasma glucose distribution (BPG) and its relevance for gestational diabetes mellitus (GDM) diagnosis were studied in Asian Indian pregnant women. METHODS: Fasting (FPG) and two hour plasma glucose (2-h PG) values of oral glucose tolerance tests performed in 36,530 pregnant women for GDM screening (2006-16 period), were analyzed for BPG. A unimodal normal and a mixture of two normal distributions were fitted to log-transformed FPG and 2-h PG data. The mixture model was compared to unimodal model for BPG using likelihood ratio test (LRT) and the comparison was further verified by bootstrapping. The cut points of the two normal distribution curves in the mixture models of FPG and 2-h PG were noted. RESULTS: Fasting and 2-h PG distribution was bimodal in all pregnant women. The comparison of mixture and unimodal models using LRT revealed p value <0.001 in all age groups. The cut points for FPG and 2-h PG were 5.81 mmol/L (95% CI: 5.69-5.92) and 8.41 mmol/l (95% CI: 8.09-8.75) respectively. CONCLUSION: BPG is noted for both FPG and 2-hPG in Asian Indian pregnant women. The cutpoints of normal distribution curves are close to threshold values for FPG and 2-h PG proposed in NICE (National Institute for health and Care Excellence) and IADPSG (International Association of Diabetes and Pregnancy Study Group) GDM diagnostic criteria respectively. Further research on BPG in pregnant women of racial groups with high GDM prevalence, is likely to be of value in GDM diagnosis.

Gestational diabetes: fasting and postprandial glucose as first prenatal screening tests in a high-risk population.

OBJECTIVE: To evaluate the value of fasting (FPG) and 2-hour postprandial (PPG) plasma glucose as screening tests for gestational diabetes mellitus (GDM) in a high-risk population during early pregnancy. STUDY DESIGN: At their first prenatal visit, 708 women underwent FPG and PPG for universal screening for GDM, with the diagnosis confirmed by the 75-g oral glucose tolerance test (World Health Organization criteria). The area under the receiver operating characteristic curve (AUC) was used to analyze the performance of the 2 screening tests. RESULTS: Of 184 (25.9%) women with GDM, 79 (42.9%) were identified before 18 weeks. The AUC for FPG to predict GDM was 0.579 (95% CI 0.531-0.627). Though a threshold of 85 mg/dL achieved minimally acceptable sensitivity, 79.9%, the corresponding specificity remained poor, 27.5%, with a false positive rate (FPR) of 72.5%. The AUC for PPG was 0.717 (95% CI 0.670-0.765); a cutoff of 95 mg/dL achieved a sensitivity of 79.9% and FPR of 53.1%. CONCLUSION: Though GDM could be diagnosed in > 40% women in early pregnancy at their first prenatal visit, the poor specificity and high FPR of FPG and PPG, alone or in combination, make them unsuitable screening tests for GDM.

Gestational diabetes in a high-risk population: using the fasting plasma glucose to simplify the diagnostic algorithm.

OBJECTIVE: To evaluate the value of fasting plasma glucose (FPG) in screening a high-risk population for gestational diabetes mellitus (GDM). STUDY DESIGN: During an 8-month period, 1685 pregnant women underwent the one-step 75 g oral glucose tolerance test (OGTT) as a part of a universal screening program. The receiver operating characteristic (ROC) curve was used to analyze the performance of the FPG. RESULTS: 333 (19.8%) women had GDM (WHO criteria). The area under the ROC curve of FPG to detect GDM was 0.639 (95% CI 0.603-0.674), which reflected the degree of the FPG histogram overlap in women with and without GDM. A FPG threshold of 4.7 mmol/l reached the minimally acceptable sensitivity of 78.1% with a corresponding unacceptable specificity of 32.2%. 508 (31%) women were below this threshold, at a negative predictive value of 85.6%. The FPG at higher thresholds with acceptable specificity had poor sensitivity and positive predictive value to be useful. CONCLUSION: Though the high false positive rate at any FPG threshold with adequate sensitivity makes the FPG an inappropriate test for GDM screening, the FPG has the potential to avoid nearly one-third of the cumbersome OGTTs at the expense of missing one-fifth of pregnant women with milder GDM.

Childhood and adolescent diabetes mellitus in Arabs residing in the United Arab Emirates.

In 9 years (1990-1998), 40 Arab patients between the ages of 0 and 18 years had newly diagnosed diabetes mellitus (DM) at the Al-Ain hospital, United Arab Emirates (UAE). In this cohort, 35 patients had Type 1 DM while the remaining five patients had features of early onset Type 2 DM. For Type 1 DM patients, the mean age at diagnosis of was 9.2+/-4.1 years. At presentation, their mean plasma glucose was 27.6+/-11/mmol with 28 (80%) patients having diabetic ketoacidosis (DKA), both being much higher than generally reported in the West. The mean insulin requirement increased from 0.84+/-0.27 U/kg per 24 h (0-9-year group) to 1.02+/-0.33 U/kg per 24 h (10-18-year group), P=0.055. The home glucose monitoring and the glycaemic control of these Type 1 DM patients were sub-optimal with 28% of patients having recurrence of DKA. Among the Type 2 DM patients, four (80%) were obese with a positive family history of Type 2 DM. All of them initially responded to diet and oral hypoglycaemic drugs. Public education about DM in childhood and prevention of adolescent obesity remain major public health challenges in the UAE.

Gestational diabetes: implications of variation in post-partum follow-up criteria.

OBJECTIVE: To compare the recommendations of the American Diabetes Association (ADA) with the World Health Organization (WHO) for evaluating women with gestational diabetes (GDM) after delivery. STUDY DESIGN: During a 5-year period, 549 patients underwent the 2h, 75 g oral glucose tolerance test (OGTT), 4-8 weeks after delivery. They were classified by the criteria of WHO (1985), the ADA [1997, fasting glucose (FPG)] and the revised WHO (1999). RESULTS: The prevalence of diabetes by WHO-1985 and ADA-1997 were similar (8.2% versus 6.6%) but estimates of impaired glucose homeostasis varied widely (15.5% impaired glucose tolerance (IGT) versus 9.3% impaired fasting glucose, respectively). 118 (21.5%) women and 83 (15.1%) women showed a classification discrepancy between ADA-1997 with the WHO-1985 and -1999, respectively. The receiver-operating characteristic (ROC) curve area of the FPG was 0.94 for DM by the OGTT (WHO-1985 criteria) but only 0.59 for IGT by the 2h post-glucose. CONCLUSIONS: The various guidelines for GDM follow-up after delivery, often based on expert opinion, produce similar estimates for diabetes prevalence but widely discordant results for glucose intolerance. Until more uniform evidence-based criteria become available, the various strategies for GDM follow-up will continue to cause confusion in clinical practice.

Gestational diabetes: an alternative, patient-friendly approach for using the diagnostic 100-g OGTT in high-risk populations.

OBJECTIVE: To simplify the 100-g oral glucose tolerance test (OGTT) for making a diagnosis of gestational diabetes mellitus (GDM). METHODS: During a 6-year period, 6,801 pregnant women underwent the 3-h, 100-g OGTT in a high-risk, multiethnic population. All these women had either a positive glucose challenge test/clinical history or were part of a universal screening protocol. The area (AUC) under the receiver-operating characteristic curve was used to compare the performance of the fasting plasma glucose (FPG), 1-h, 2-h and 3-h glucose values for GDM diagnosis. Ideal cut-offs of the best performing glucose value alone and in combination were used to find the best predictor for GDM with minimal loss of sensitivity and specificity. RESULTS: Using the American Diabetes Association criteria, 2,127 (31.3%) women were classified as having GDM. The 2-h value was the best performing (AUC 0.933) glucose value; at an optimal cut-off of >or=8.6 mmol/l, the sensitivity was 83.6% with a specificity of 92.8%. It did not achieve sufficient collective specificity and sensitivity at various thresholds to be useful. However, in combination with FPG (either FPG >or=5.3 mmol/l or 2-h >or=8.6 mmol/l) or (either FPG >or=5.6 mmol/l or 2-h >or=8.6 mmol/l), the sensitivity/specificity were 98.5%/84.7% and 92.5%/89.3%, respectively. CONCLUSION: An abbreviated 100-g OGTT, using only the FPG and 2-h glucose value, may be a useful alternative in high-risk populations to make a diagnosis of GDM by being cost-effective and patient-friendly.

Thyroid function abnormalities and antithyroid antibody prevalence in pregnant women at high risk for gestational diabetes mellitus.

Both gestational diabetes mellitus (GDM) and thyroid dysfunction in pregnancy compromise maternal and fetal health. The aim of the present study was to determine the prevalence of abnormal thyroid function and antithyroid antibodies during early pregnancy in a population at high risk for GDM. Serum free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were measured in 301 pregnant women who underwent routine 'universal screening' for GDM. The antithyroid peroxidase antibody (antiTPOAb) was also quantified in 255 of these women. GDM was confirmed by a 75-g oral glucose tolerance test using World Health Organization criteria. No statistically significant difference was found between the 80 (26.6%) women with GDM and the 221 (73.4%) women without GDM for any of the thyroid function tests. In the cohort tested for antiTPOAb, the 51 (20.0%) women who were positive for antiTPOAb had higher mean TSH (1.57 +/- 2.49 mIU/l; p < 0.001) than the women negative for antiTPOAb. Seventeen (5.6%) women had low FT4 while 12 (4.0%) women had high TSH; 28 (9.3%) women had low serum TSH, among whom three (1.0%) also had high FT4. The significantly higher prevalence of hypothyroxinemia and antiTPOAb titers than generally reported warrants routine screening for thyroid abnormalities. This screening, which can be effectively and easily incorporated into screening practices already in place for GDM, would result in improved obstetric care.

Gestational diabetes: a reappraisal of HBA1c as a screening test.

BACKGROUND: Recent technological advances have made HBA1c a more standardized and user-friendly test with wide availability. This study evaluated HBA1c as a screening test for gestational diabetes mellitus (GDM) in a high-risk population. METHODS: A total of 442 pregnant women were assessed by HBA1c. Two thresholds were used to "rule in or rule out" GDM, which was confirmed by the "gold-standard" 75-g OGTT (World Health Organization criteria). RESULTS: Eighty-four (19%) women had GDM while 358 (81%) women were normal; there was a complete overlap of the HBA1c histograms of the two populations. The area under receiver operating characteristic curve of HBA1c to detect GDM was 0.54 (95% CI 0.48-0.61). Using a value of <5.5% to rule out GDM; a sensitivity of 82.1% was achieved, with 15 (16.7%) of 90 women below the threshold being false-negatives (NPV = 83.3%). Using a threshold of HBA1c > or = 7.5% to rule-in GDM; the specificity was 95.8% with 15 (71.4%) of 21 patients over the threshold being false-positives (PPV = 28.6%). HBA1c would eliminate the need for an OGTT in 25.1% (111/442) of whom 27% (30/111) women would be misclassified. At any HBA1c threshold with an acceptable sensitivity, the false-positive rate remained high making it necessary for too many healthy women to undergo the confirmatory OGTT. CONCLUSION: Despite all the progress in methodology, HBA1c remains a poor test to screen for GDM.

Recent advances in the treatment of gestational diabetes.

Despite four decades of research there is a lack of international consensus on the screening, diagnosis, treatment and follow up of gestational diabetes mellitus (GDM). Currently, GDM is managed by diet modification, exercise and exogenous human insulin. During the last decade, several insulin analogues and oral antihyperglycaemic drugs have revolutionised the management of diabetes mellitus in non-pregnant women. Most of these recent drugs still remain investigational in GDM due to concerns about their safety in pregnancy. This review will focus primarily on the pharmacological treatment of GDM. It will objectively assess the value of these exciting new drugs in pregnancy as they could potentially benefit every woman with GDM.