Is metformin a better alternative than a sulfonylurea as initial treatment for gestational diabetes?

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Yes. In patients with gestational diabetes, glucose management with metformin results in a 67% decreased risk of macrosomia and approximately 200 g lower birth weight than glyburide. Metformin also leads to less maternal weight gain (SOR: A, meta-analyses of RCTs). The differential effect on neonatal hypoglycemia is unclear.

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