Pregnancies affected by gestational diabetes mellitus (GDM) are associated with an increased risk of adverse maternal and foetal outcomes. Current treatments for GDM involve initial medical nutritional therapy (MNT), exercise and pharmacotherapy in those with persistent hyperglycaemia. Insulin is considered first-line pharmacotherapy in many countries but is associated with hypoglycaemia, excessive gestational weight gain (GWG) and an increased caesarean delivery rate. Metformin is also used and is safe in selected groups (BMI >30) of women with GDM but is not first-line therapy in many countries. To date a randomised placebo controlled trial of metformin in the treatment of women with GDM has not been completed. The EMERGE trial will address this gap and will evaluate the effectiveness of early initiation of metformin in women with GDM across all BMI categories and where the GDM diagnosis is made using WHO 2013 criteria. The presentation will cover the rationale and background to the trial, the protocol, impact of COVID, drug adherence and baseline characteristics of women randomised.