What is the standard first-line treatment for gestational diabetes?

• A. Lifestyle modification and, if needed, pharmacotherapy such as insulin or metformin as appropriate per guidelines
• B. Insulin therapy only
• C. Metformin monotherapy only
• D. Diet alone with no pharmacotherapy

Answer: (A)

Managing gestational diabetes starts with controlling glucose through lifestyle changes, then adding medication if needed. A balanced, carbohydrate-controlled diet and regular physical activity help lower blood sugar and reduce insulin resistance during pregnancy. After these measures, if fasting or postprandial levels remain above target, pharmacotherapy is introduced according to guidelines. Insulin has long-standing safety data in pregnancy and is commonly used, while metformin is also an acceptable option in many guidelines depending on individual circumstances. This stepwise approach—lifestyle modification with pharmacotherapy added as needed—captures the standard first-line strategy.