The primary objective of GDM care is to achieve good glycemic regulation that prevents/reduces fetal as well as maternal complications (Kim, 2010). A basic change in maternal and fetal outcomes was seen in the timely identification of GDM and treatment intervention with good glycemic regulation (Crowther et al., 2005).

Compared with those in the intervention group (dietary advice / insulin therapy) in a review of pregnancy outcomes among participants in the Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS), who received routine therapy. The findings showed that counselling substantially decreased the danger of perinatal morbidity as well as showed that maternal anxiety and well-being were alleviated (He et al., 2016). Among the classes, rates of cesarean delivery were similar. An analysis of moderate gestational diabetics in the United States showed that there was a drop in mean birth weight, shoulder dystocia, neonatal fat mass and LGA among the fetal outcomes under care. In either party, no perinatal deaths occurred. Elevated cord blood C-peptide, hyperbilirubinemia, neonatal hypoglycemia, and birth trauma were the criteria which did not show any difference with treatment. The maternal parameters showing a substantial decrease were the number of deliveries by cesarean section and pre-eclampsia (Landon et al., 2009). Between intervention and routine care classes, the need for induction of labor was the same. A systematic review and meta-analysis concluded that fetal complications of macrosomia, Broad for Gestational Age (LGA), and shoulder dystocia and maternal hypertension were minimized by GDM therapeutic intervention. No major effects were observed on preterm delivery, labour induction requires, cesarean sections, pre-eclampsia, birth trauma, perinatal or neonatal morbidity and neonatal hypoglycemia (Poolsup, Suksomboon, & Amin, 2014). Another systematic study involving 12 studies found that the occurrence of macrosomia and shoulder dystocia was substantially decreased by GDM care. No major reductions in the number of small babies in gestational age or perinatal/neonatal deaths were observed (Horvath et al., 2010). Further studies have shown that the risk of developing type II diabetes in mothers has been minimized by adequate treatment of GDM (Horvath et al., 2010). Clinical research in females having prior exposure of GDM who were on pharmacological treatment or lifestyle intervention found that diabetes mellitus progression was reduced/delayed by up to 50% relative to those treated with placebo. The need for GDM care is aimed at ensuring minimal/nil prenatal complications as well as avoiding/delaying the production of mother and child metabolic disorder(s) (Seshiah, Banerjee, Balaji, Muruganathan, & Das, 2014). Strict glucose regulation and good glycemic control are involved in GDM management. Glucose levels, i.e. fasting glucose, can be tracked up to 4 times/ day and one hour after having each meal has started. After fasting, the predicted glucose levels are 70-90mg/dl and below 120mg/dl post-prandial (Elshahidi, 2019). A fasting glucose target of approximately 90 mg/dl and a 2-hour post-prandial glucose target of approximately 120 mg/dl have been reported in the Indian DIPSI recommendations (Seshiah et al., 2014).

The recommendation of medical nutritional therapy (MNT) and lifestyle changes involving physical activity is the first step towards maintaining glycemic control (Greuter, van Emmerik, Wouters, & van Tulder, 2012). A research from India on a detailed GDM management protocol, entitled the WINGS project, suggested two weeks of MNT and life-style intervention to follow. If normal glycemic regulation with MNT can be achieved, daily glucose level monitoring should be followed (Yuen & Wong, 2015). In the absence of optimum glucose levels with MNT, it was recommended that insulin or metformin therapy be initiated to treat diabetes (Duncan, 1882). The WINGS project proposed that only insulin be used (Yuen & Wong, 2015). A research also indicated that the dosage of insulin should be modified according to the needs of the particular patient. A systematic study on GDM treatment during pregnancy also found that the use of insulin over oral hypoglycemic medication was favoured by several global protocols (Greuter et al., 2012). MNT requires dietary intake control. The key goal of the MNT was to ensure fetal growth and to avoid ketosis (Kim, 2010). The control of caloric intake during GDM has been modified based on prenatal BMI. For women with normal and increased BMI groups, ACOG recommended caloric intake, composition and distribution (Goetzl, 2002). The goal of diet regulation was to maintain optimum gestational weight gain without compromising on fetal nutrition and growth and also without ketosis, as per Institute of Medicine (IOM) guidelines. The caloric intake requirement was similarly suggested by the Ministry of Health and Family Welfare of India. To calculate the daily energy requirement as per BMI and the degree of physical activity, be it sedentary, moderate or strong, a set of formulas has been established. 350 kcal per day was applied to the adult female energy requirement to meet the energy requirement of a pregnant woman. Finally, in the case of underweight BMI, 500kcal/day was added to the regular requirement and in the case of obese women; 500kcal/day was deducted from the requirement. In summary, the Indian recommendation has taken into account the type of physical activity performed by the subject in the calculation of the calories required per day and is also based on Indian BMI cut-off values. The role of exercise was to increase the sensitivity of insulin. Exercise to decrease the need for insulin has been documented and has also helped maintain adequate glycemic control (de Barros, Lopes, Francisco, Sapienza, & Zugaib, 2010; Horton, 1991). Exercise regimens adopted by GDM mothers have been found to decrease insulin therapy requirements and doses and also boost glycemic control (Cremona, O'Gorman, Cotter, Saunders, & Donnelly, 2018; Sanabria‐Martínez et al., 2015).

Insulin or other medical pharmacological options should be started in subjects whose fasting and post-prandial glucose levels are not lowered by MNT (Dirar & Doupis, 2017; Elshahidi, 2019). A study stated that the majority of studies insist that only insulin is used to control GDM. Studies have confirmed, however, that oral hypoglycemic agents such as metformin can be used in GDM and have been successful in preventing complications in pregnancy, and that the protective effects of metformin are comparable to those of insulin. The investigators found that patients preferred to use metformin as opposed to insulin (Liang, Ma, Xiao, & Tan, 2017; Rowan, Hague, Gao, Battin, & Moore, 2008). Studies have been performed on the development of alternative medicinal therapies such as glyburide and glibenclamide in the treatment of GDM. Both therapies have been tested in terms of their success in preventing maternal and fetal GDM complications as well as maintaining tight glycemic regulation (Jayasingh Sr et al., 2020; Maqbool & Gani, 2018; Maqbool, Naeem, & Aamer, 2018).

Milk and drugs from the Madhura category are recommended during pregnancy, according to Ayurvedic texts. At certain stages of pregnancy, additional dietary components such as honey, ghee, freshly made butter, meat soup, krishra (khichadi), and paayas (kheera) are added. Overall, the diet recommended is high in micronutrients and beneficial to both mother and child's health. Milk is a complete diet, and madhura varga medicines are both nourishing and antioxidant. Preventing gestational diabetes with a daily snack of leafy green vegetables, fruit, and milk has been shown in clinical trials. Yoga helps to alleviate anxiety, depression, and other unpleasant pregnancy symptoms. Incorporating yoga into regular pregnancy will help with anxiety, depression, and overall well-being. Yoga can potentially be an effective therapy in minimizing GD, hypertensive-related pregnancy complications, and improving fetal outcomes, according to a randomized study conducted in high-risk pregnancies (Chandla, Tomer, & Gupta, 2017; Chen et al., 2017; Sathananthan et al., 2015). In addition, studies have shown that the systematic and healthy implementation of a yoga therapy module can be effective in reducing stress levels in high-risk pregnancies (GDM). Yoga has previously been shown to improve the quality of life of pregnant women, improve their ability to perform social roles, and potentially avoid adverse obstetric outcomes in a noninvasive, cost-effective, and simple-to-learn study. Pregnancy is a unique phase in a woman's life, and yoga will provide her with the ability and resources to make the most of it. Meditation, breathing, and calming exercises, all of which are important components of yoga, have been shown to have a significant and beneficial effect on the autonomic nervous system's behaviours in pregnant women (Chandla et al., 2017; Deshpande et al., 2013; Khan & Maqbool; Maqbool, Dar, et al., 2019; Rakhshani, Maharana, Raghuram, Nagendra, & Venkatram, 2010).

Punica granatum, Trigonella foenum graecum, Gymnema sylvestre, Aloe vera, Azadirachta indica, Acacia arabica, Momordica charantia, Eugenia jambolana, and others are single drugs used in formulations with anti-diabetic and associated beneficial properties in GDM. With a comprehensive approach that involves numerous photochemical groups such as alkaloids, terpenes, and phenolics, phytomedicine used in Unani medicine offers an exciting potential for the creation of new forms of therapeutics for diabetes mellitus. These medications include antioxidants, bitter, and other activity linked to carbohydrate metabolism disturbances, in addition to hypoglycemic activity. Roghane Qusht, Sharbate Afsanteen, Qurse Tabasheer, Qurse Dhayabitus, Qurse Marwareed, Qurse Gulnar, Dawaul Misk Talkh, Safoof Gilo, and Ma-Usshaeer are some of the decoctions, infusions, capsules, pills, and powders used. Qurs Ziabetus, Qurs Kushta baiza murgh, Dolabi pills, Qurs Kushta Zamarrud, Diab-eaze, Safoof Ziabtes, and other commonly marketed formulations (Hamiduddin, Ali, Jahangeer, & Al, 2018; Maqbool, Khan, Mohammad, Adesina, & Fekadu, 2019; Zehravi, Maqbool, & Ara, 2021).