It's the latest breakthrough for the reigning European champions, who have gone from strength to strength since teaming up in the spring of 2023.
"It's the best day of my life," an emotional Berulava told reporters.
"I'm so very happy. It's an amazing moment for my country. I have no words. I'm shocked."
After Japan's Riku Miura and Ryuichi Kihara delivered a world record-breaking performance, Metelkina and Berulava found themselves in a tense battle for second place with the teams from Germany, Hungry and Canada.
Metelkina fought to hold onto a crucial landing on their throw triple loop, and avoiding that fall was likely the difference between a silver medal and finishing off the podium.
"No!" Metelkina said with a laugh when asked to describe what was going through her mind in the moment.
"I'm used to landings. It happened how it happened. There is still space to grow and, we will improve our performance."
The Japanese staged a thrilling comeback to win gold with a score of 231.24, while Metelkina and Berulava secured silver with 221.75.
Minerva Fabienne Hase and Nikita Volodin of Germany, the leaders following Sunday's short programme, had to settle for bronze with 219.09.
Metelkina, 20, and Luka Berulava, 23, said managing their time and fitness over four performances at the Games - two in the team event and two in the pairs competition - was key to their success.
They said they will use the experience they gained in Milan when they compete at future Games with even bigger aspirations.
"We won't say whether we will reach the gold medal next time, spend all of our energy on it," she said.
