[Clinical practice recommendations for diabetes in pregnancy (Update 2023)]

Area of Science:

• Reproductive Endocrinology
• Diabetology
• Maternal-Fetal Medicine

Context:

• The St. Vincent Declaration (1989) aimed for comparable pregnancy outcomes for women with and without diabetes.
• Despite this, women with pre-gestational diabetes still experience higher rates of perinatal morbidity and mortality.
• This disparity is linked to inadequate pregnancy planning and pre-conception metabolic control.

Purpose:

• To highlight the persistent challenges and risks in managing pregnancies in women with pre-gestational diabetes.
• To emphasize the importance of pre-pregnancy care, including metabolic control, screening for comorbidities, and optimized therapy.
• To discuss current treatment strategies and their efficacy in achieving optimal outcomes.

Summary:

• Optimal pre-pregnancy care is essential, involving stable glycemic control and management of comorbidities like thyroid dysfunction and hypertension.
• Near-normoglycemia and normal HbA1c are treatment targets, minimizing hypoglycemia, especially in early pregnancy for type 1 diabetes.
• Intensified insulin therapy, continuous glucose monitoring, and cautious use of oral agents like Metformin (for type 2 diabetes) are key management strategies.
• Regular obstetric care and interdisciplinary approaches are vital for monitoring and ensuring healthy fetal development.

Impact:

• Improved understanding of the critical need for pre-conception care in diabetic pregnancies.
• Provides evidence-based recommendations for optimizing metabolic control and reducing maternal-fetal risks.
• Informs clinical practice regarding treatment choices and the necessity of a multidisciplinary approach for better pregnancy outcomes.