Diabetes and Pregnancy: A Clinical Practice Guideline Education Activity-Guideline: Preexisting Diabetes and Pregnancy

Pdf Summary

This Joint Clinical Practice Guideline, developed by the Endocrine Society and European Society of Endocrinology, provides evidence-based recommendations for managing preexisting diabetes mellitus (PDM), including type 1 (T1DM) and type 2 diabetes mellitus (T2DM), in individuals before, during, and after pregnancy to reduce maternal and neonatal adverse outcomes.<br /><br />Key recommendations include:<br /><br />1. Screening for pregnancy intention should be incorporated at all reproductive health, diabetes, and primary care visits to facilitate preconception care (PCC), which is associated with improved glycemic control and reduced congenital malformations. Clinician counseling on contraception is advised when pregnancy is not desired.<br /><br />2. Discontinuation of glucagon-like peptide-1 receptor agonists (GLP-1RAs) before conception is suggested over stopping after pregnancy begins, to minimize potential fetal risks and manage the transition to insulin while avoiding hyperglycemia.<br /><br />3. Routine addition of metformin to insulin therapy in pregnant individuals with T2DM is not recommended due to uncertain benefits and potential risks like small for gestational age infants and adverse childhood outcomes.<br /><br />4. Either a carbohydrate-restricted diet (approximately 175g/day) or usual diet can be used during pregnancy, as evidence is insufficient to recommend one approach over the other, though both very low and very high carbohydrate intakes may be harmful.<br /><br />5. For pregnant individuals with T2DM, either continuous glucose monitoring (CGM) or self-monitoring of blood glucose (SMBG) are reasonable; CGM may offer advantages but direct evidence of superiority in pregnancy is limited.<br /><br />6. When using CGM, standard pregnancy glucose targets for fasting and postprandial levels should guide insulin adjustments rather than relying on a single 24-hour glucose target.<br /><br />7. In pregnant women with T1DM, hybrid closed-loop insulin pumps (automated insulin delivery based on CGM data) are suggested over insulin pump or multiple daily injections with CGM due to improved glucose control metrics.<br /><br />8. Early delivery based on individualized risk assessment is advised rather than expectant management beyond 38 weeks gestation, recognizing the increased risks of stillbirth and maternal complications.<br /><br />9. Postpartum endocrine care, including diabetes management, in addition to routine obstetric care, is important, especially as the postpartum period often overlaps with preconception and is critical for glycemic management, breastfeeding support, and planning future pregnancies.<br /><br />Overall, the evidence supporting these guidelines ranges from very low to moderate certainty, highlighting a need for further research on optimal glycemic targets, nutrition, technology use, and timing of delivery in PDM. Implementation of PCC and advanced diabetes technologies holds promise for improving outcomes. The guideline emphasizes patient-centered, shared decision-making, equitable care, and multidisciplinary approaches throughout reproductive care for individuals with diabetes.

Meta Tag

Concept Maternal Diabetes

Concept Preconception Care

Concept Blood Glucose Monitoring

Concept Glucose Management Goals

Concept Postpartum Care

Keywords

preexisting diabetes mellitus

type 1 diabetes mellitus

type 2 diabetes mellitus

pregnancy management

preconception care

glucagon-like peptide-1 receptor agonists

metformin

carbohydrate-restricted diet

continuous glucose monitoring

hybrid closed-loop insulin pumps

Maternal Diabetes

Preconception Care

Blood Glucose Monitoring

Glucose Management Goals

Postpartum Care


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