**Table 5.**

*Glucose targets recommended for GDM treatment [124].*

Pharmacological (mainly insulin) treatment of GDM is considered in cases where we are unable to achieve the treatment goals through dietary modification and lifestyle management. Insulin is indicated when glycaemia exceeds the recommended range (**Table 5**).

In GDM, the reason for insulin preference dominance is good efficacy in glycaemic control and the low risk of foetal harm with the negligible transplacental transfer. Metformin has the most experience worldwide. However, in our centre, metformin is not currently recommended in the management of GDM. It is known to cross placenta and a long-term safety for offspring is still of some concern [124].

The relationship between hyperglycaemia at 24–28 weeks of pregnancy and the incidence of perinatal complications is well established. This is not entirely true for the detection of hyperglycaemia in early pregnancy. We have insufficient data to establish target glycaemic values for the diagnosis and treatment of early onset gestational diabetes. However, increased fasting glycaemia in early pregnancy has shown to be closely associated with higher body mass and BMI in the initial weeks of pregnancy [125]. Women with GDM had more pronounced features of metabolic syndrome than pregnant women without GDM in terms of lipid profiles (triglycerides) and increased insulin production (C-peptide) [126]. Women with early onset GDM also showed altered adipokine production. Increased A-FABP and decreased adiponectin levels are correlating with visceral adiposity and glucose control and may be affected by treatment later in pregnancy [127].

It turns out that gestational diabetes is a heterogeneous condition. Further research is now focusing on finding potential different screening strategies and diagnostic criteria in early and late pregnancy. At the same time, it is necessary to look for appropriate treatment approaches for women with hyperglycaemia at different stages of pregnancy in terms of efficacy and safety [128].
