Abstract: The diagnosis of gestational diabetes mellitus （GDM） indicates that the gravida has a predisposition to diabetes. Essentially, women at risk of type 2 diabetes are also at risk of GDM. The medical management of GDM should focus on dietary therapy, physical activity and pharmacotherapy, which is the same as therapeutic principle of type 2 diabetes. Choices of treatment drugs in pregnant patients should take into account of the effects on the fetus. There is a controversy regarding the use of oral hypoglycemic agents during pregnancy. Insulin has been the unique choice of treatment in most parts of the world for GDM. Evidence is inadequate to support the use of oral hypoglycemic agents, an agent that has been shown to cross the placenta and thus could be harmful to the developing fetus including neonatal hypoglycemia and malformations. There have now however, been animal experiments and randomized trials conducted with metformin, glyburide and acarbose, which have not demonstrated harm to the pregnancy in malformations. Although most of randomized trials have demonstrated noninferiority of glyburide and metformin in achieving glycemic control, and satisfactory birth outcomes compared to insulin therapy, concerns must remain as long-term issues have not yet been addressed. Further sufficiently powered and randomized clinical studies are still needed in order to determine the role of oral hypoglycemic agents as an alternative treatment to insulin in GDM patients.

Key words: Gestational diabetes mellitus, Glyburide, Metformin, Acarbose