Results from the MiG trial, a randomized controlled trial of more than 700 pregnant women with GDM in New Zealand and Australia who either received metformin or insulin, showed that metformin was not associated with an increased risk of neonatal complications (neonatal hypoglycemia, acute respiratory distress syndrome, need for phototherapy, and birth trauma) or maternal complications (excessive gestational weight gain, poor glycemic control, and hypertension-related complications) compared to insulin [11]. This evidence concerns the gene INS and acute respiratory distress syndrome.