ABSTRACT
Obese women are at increased risk of developing gestational diabetes mellitus (GDM) because they are more likely to enter pregnancy with preexisting insulin resistance. Dietary modification with home blood glucose monitoring is the first-line management for GDM in obese pregnant woman. In many women, dietary modification achieves acceptable glycemic control and no further treatment is required. However, in women with GDM who remain hyperglycemic despite dietary modification, pharmacological therapy is the next stage in management. In obese nonpregnant women with type 2 diabetes, the apparent clearance and volume of distribution of metformin are influenced by the lean body weight. Fetal outcomes There is no evidence that metformin treatment is associated with increased risk of congenital anomalies. Maternal outcomes Glibenclamide is generally well tolerated by women during pregnancy. The increased insulin resistance associated with obesity in pregnancy may mean that insulin requirements are greater for obese women with GDM than for women of normal weight.
