Insulin therapy is recommended in women with GDM when MNT and self-blood glucose monitoring have not been adequate to maintain desirable plasma glucose levels (fasting: <105 mg/dl; 1-hour postprandial <155 mg/dl or 2-hour postprandial <130 mg/dL) and to prevent excessive maternal weight gain, macrosomia and fetal morbidity and mortality.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.