{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:58:01Z","timestamp":1786121881712,"version":"build-2736575974"},"reference-count":93,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004543","name":"China Scholarship Council","doi-asserted-by":"publisher","award":["202506180006"],"award-info":[{"award-number":["202506180006"]}],"id":[{"id":"10.13039\/501100004543","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Pharmacologic treatment is widely used for managing gestational diabetes mellitus (GDM). However, evidence remains limited on the comparative effectiveness and safety across different drug classes for GDM. This study aims to compare the efficacy and safety of pharmacologic treatments for GDM using network meta\u2010analysis of randomised controlled trials (RCTs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science up to May 16, 2025 to identify trials evaluating glucose levels and maternal or neonatal complications in GDM patients using any pharmacologic agents, e.g., insulin, biguanides, sulfonylureas, \u03b1\u2010glycosidase inhibitors, sodium\u2010glucose cotransporter\u20102(SGLT\u20102) inhibitors, dipeptidyl peptidase IV(DPP\u2010IV) inhibitors or Glucagon\u2010like peptide\u20101receptor (GLP\u20101 RAs) versus standard care. We used random\u2010effects model for both pairwise meta\u2010analyses and frequentist network meta\u2010analyses and applied the Confidence in Network Meta\u2010Analysis (CINeMA) framework to assess the certainty of evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventy\u2010three articles were eligible, comprising 71 trials in which 14\u2009877 participants were enrolled and seven drug classes assessed. All subsequent effects refer to comparisons with standard care. Because of their moderate to high evidence of certainty, sulfonylureas were established as the most effective drugs used for lowering fasting glucose (mean difference [MD]: \u22120.33\u2009mmol\/L; 95% confidence interval [CI]: \u22120.55 to \u22120.1), followed by insulin (MD: \u22120.3\u2009mmol\/L; 95% CI: \u22120.4 to \u22120.21) and biguanides (MD: \u22120.2\u2009mmol\/L; 95% CI: \u22120.28 to \u22120.12). Biguanides were the most effective drugs used to control haemoglobin A1c (MD: \u22120.1%; 95% CI: \u22120.16 to \u22120.03), but their use was associated with increased adverse events leading to low birth weight among infants (OR: 2.04; 95% CI: 1.04\u20134.01). Insulin (OR: 0.51; 95% CI: 0.34\u20130.75), biguanides (OR: 0.39; 95% CI: 0.26\u20130.59), and sulfonylureas (OR: 0.5; 95% CI: 0.31\u20130.79) use could decrease the risk of macrosomia. Sulfonylureas were found to be more easily get premature delivery and neonatal hypoglycaemia than biguanides; evidence regarding their impact on low birth weight and long\u2010term safety remains lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Insulin use provides significant benefits in achieving glycaemic control and minimising maternal and foetal complications, and it has a favourable overall safety profile. Biguanide use may be associated with an increased risk of low birth weight, warranting careful consideration and thorough counselling for shared decision\u2010making. Currently, insufficient evidence supporting the efficacy and safety of sulfonylureas, \u03b1\u2010glycosidase, DPP\u2010IV, and SGLT\u20102 inhibitors; and GLP\u20101 RAs in GDM management is available.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.70823","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:06:33Z","timestamp":1777939593000},"page":"5542-5555","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pharmacological Treatment for Gestational Diabetes Mellitus: A Systematic Review and Network Meta\u2010Analysis of 71 Randomised Controlled Trial"],"prefix":"10.1111","volume":"28","author":[{"given":"Xiaowei","family":"Liu","sequence":"first","affiliation":[{"name":"The First School of Clinical Medicine Lanzhou University  Lanzhou China"},{"name":"Department of Obstetrics and Gynecology the First Hospital of Lanzhou University, Key Laboratory of Gynecologic 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DeGroote Institute for Pain Research and Care McMaster University  Hamilton Canada"},{"name":"Department of Anesthesia McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7864-3012","authenticated-orcid":false,"given":"Kehu","family":"Yang","sequence":"additional","affiliation":[{"name":"Evidence\u2010Based Medicine Center, School of Basic Medical Sciences Lanzhou University  Lanzhou China"},{"name":"Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province  Lanzhou China"},{"name":"Evidence\u2010Based Social Science Research Center, School of Public Health Lanzhou University  Lanzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"2013","volume-title":"Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy","author":"World Health O","year":"2013"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00825-0"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/obr.13934"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc25-S015"},{"key":"e_1_2_10_6_1","volume-title":"Management of Gestational Diabetes in the Community","author":"Federation ID, Foundation MDR","year":"2024"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcjd.2017.10.038"},{"key":"e_1_2_10_8_1","volume-title":"Management of Diabetes in Pregnancy","author":"Network S. 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