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Preexisting Diabetes and Pregnancy: An Endocrine S ...
Preexisting Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guidelines (CPG01)
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The joint clinical practice guideline from the Endocrine Society and European Society of Endocrinology addresses management of pre-existing diabetes in pregnancy. Developed through a rigorous, evidence-based GRADE methodology, the guideline emphasizes multidisciplinary input and reflects global considerations across diverse healthcare systems.<br /><br />Key highlights include:<br /><br />- Preconception care is paramount, shown to reduce adverse maternal and neonatal outcomes such as congenital malformations by 71%, yet uptake remains inadequate worldwide. Screening for pregnancy intent is recommended at all care visits.<br /><br />- Postpartum endocrine care is advised to support glycemic management, breastfeeding, and long-term health.<br /><br />- Contraception counseling is essential, with patient-centered shared decision-making encouraged.<br /><br />- GLP-1 receptor agonists (like semaglutide) should be discontinued prior to conception due to limited safety data and potential teratogenic risk associated with rebound hyperglycemia if stopped abruptly in early pregnancy.<br /><br />- Insulin is the mainstay of glycemic control; adding metformin in insulin-treated type 2 diabetes is generally not recommended due to uncertain long-term offspring effects and inconsistent trial results, although individualization is needed.<br /><br />- Nutritional recommendations remain unclear due to insufficient data, highlighting a critical gap in guidance on carbohydrate intake and dietary composition.<br /><br />- Continuous glucose monitoring (CGM) or self-monitoring is suggested during pregnancy, recognizing differences in glycemic targets for type 2 versus type 1 diabetes.<br /><br />- Hybrid closed-loop insulin pump systems are conditionally recommended for pregnant women with type 1 diabetes, based on improved nocturnal glucose control, though data is limited.<br /><br />- Delivery timing should be based on individualized risk assessment to balance stillbirth risks and neonatal intensive care admissions, with early delivery favored in high-risk cases despite limited direct evidence.<br /><br />The guideline underscores the urgent need for more research on diabetes therapeutics during pregnancy, long-term offspring outcomes, nutritional management, and technology use, aiming to optimize maternal and neonatal outcomes globally.
Keywords
pre-existing diabetes in pregnancy
Endocrine Society guideline
European Society of Endocrinology
preconception care
postpartum endocrine care
contraception counseling
GLP-1 receptor agonists
insulin therapy
metformin use in pregnancy
nutritional recommendations
continuous glucose monitoring
hybrid closed-loop insulin pump
delivery timing in diabetic pregnancy
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