In pregnancy, what is the preferred initial management for gestational diabetes?

• A. Dietary modification and exercise; if needed, insulin is the preferred pharmacologic therapy; metformin or glyburide are used in some settings but insulin remains standard.
• B. Insulin therapy only, with no dietary changes.
• C. Metformin as first-line therapy for all gestational diabetes.
• D. No treatment is necessary; sugar intake should continue normally.

Answer: (A)

Gestational diabetes is managed with a stepwise approach that starts with lifestyle changes. Dietary modification and regular physical activity help control blood glucose and reduce fetal exposure to high glucose levels. If these measures keep glucose in target ranges, no medication is needed. When they don’t, pharmacologic therapy is added. Insulin is the preferred drug because it reliably lowers maternal glucose and does not cross the placenta, protecting the fetus while allowing precise dosing. In some settings, metformin or glyburide are used as alternatives, but insulin remains the standard due to its long safety record and consistent efficacy in pregnancy.