Metformin is increasingly being used to manage GDM in Australia. Although there is good randomised controlled trial evidence for its benefits during pregnancy, long term effects remain uncertain. The aim of this project was to describe the uptake of metformin when prescribed using a standardised approach to informed patient agreement. Consecutive pregnant women with diabetes were reviewed in the Campbelltown Hospital Antenatal Clinic by either an Endocrinologist or Credentialed Diabetes Educator. Women with frequent hyperglycaemia (x3 FBGL >5.2mmol/L and/or 2 hour >6.7 mmol/L) in spite of self-management and dietetic advice were advised that medication was now required. An information leaflet was provided and discussed, including treatment options (Metformin or insulin), drug modes of action, Metformin dose regimen, along with the possible side effects of each medication and the fact that metformin crossed the placenta. Women were given the option of which treatment to commence. Data from those patients who declined Metformin and the reason for decline were collected. From February 2015 until May 2016, 125 pregnant women with diabetes have been commenced on Metformin. Only sixteen women (12.8%) declined the medication, opting for insulin therapy. Half of those women listed the reason for declining Metformin as a concern that the fetus was exposed to metformin. Nine (7.2%) of women stopped metformin due to gastrointestinal side effects. Approximately 10-12 women were advised by pharmacists not to use metformin during pregnancy in spite of being given a script. We conclude that few women decline metformin using an informed patient agreement in spite of knowing that metformin crosses the placenta. In view of the uncertainty over the long term effects of metformin, we recommend using a standardised approach ensuring patient consent to prescribing metformin. Several local pharmacists require education over the use of metformin in pregnancy.