Start with lactation!

Encourage women to breastfeed their infant!

The increased risk of infants born to women with diabetes for childhood obesity and the later development of impaired glucose intolerance and diabetes is reduced by breastfeeding. It may also facilitate postpartum weight loss and reduce maternal and neonatal risk for the later development of DM type 2. Therefore:

R 6.2a Breastfeeding is recommended for both GDM and overt DM cases, whenever possible. (1++++)

Oral anti-hyperglycemic agents should not be a dilemma whether to breastfeed or not.

Metformin's concentrantions in breast milk are generally low, and the mean infant exposure to metformin has been reported well below the level of concern for breastfeeding. Glyburide was not detected in breast milk, and hypoglycemia was not observed in nursing infants of women using glyburide. So:

R 6.2b If metformin or glyburide were successfully used during pregnancy, should also be used during breastfeeding, when necessary. (1++++)