Do you prioritize dietary modifications and exercise over early pharmacologic interventions, such as metformin or insulin, for women diagnosed with gestational diabetes?

Most women with gestational diabetes are diagnosed in their late second/ early third trimester after a standard oral glucose tolerance test. Some women may be diagnosed earlier in their pregnancy and perhaps even had undiagnosed pre-gestational diabetes. Rarely, a patient can develop type 1 diabetes during pregnancy. Assuming there is no concern for type 1 diabetes, the general approach after a diagnosis of gestational diabetes is to refer the patient for ethnically appropriate nutritional counseling and to have her start testing glucose at least before breakfast and 1-2 hours after meals. Current glucose goals(American Diabetes Association) are:

• pre-meal < 95 mg/dl
• 1 hour post meal <140 mg/dl
• 2 hours post meal <120 mg

If the baby has macro...