Pazzagli L, Abdi L, Kieler H, et al. - Researchers investigated how metformin use vs insulin use for gestational diabetes (GDM) correlates with caesarean section (CS) and delivery of a large-for-gestational age (LGA) infant. Linking the Swedish population health registers, they identified 2,467 pregnant women from 2012 to 2016 without preexisting diabetes and with a first filled prescription of insulin or metformin in trimester 2 or 3; The women were categorized into those treated with insulin only (88%), metformin only (7.6%), or both insulin and metformin (4.3%). Findings yielded no evidence suggesting metformin use alone to have a higher correlation with CS compared with insulin use for treatment of GDM but it had a protective effect against delivery of a LGA infant. Increased odds for delivery by CS were identified for women necessitating treatment with both insulin and metformin, which in turn may indicate that the need for the use of both medications to treat GDM suggests a pregnancy at higher risk.