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Management of monogenic diabetes in pregnancy: A narrative review

Mohammad Sadiq Jeeyavudeen1, Sarah R Murray2, Mark W J Strachan3

  • 1Metabolic Unit, Western General Hospital, Edinburgh EH4 2XU, United Kingdom. mohammadsadiqj@gmail.com.

World Journal of Diabetes
|February 5, 2024
PubMed

Pregnancy in women with monogenic diabetes is potentially complex, with significant implications for both maternal and fetal health. Among these, maturity-onset diabetes of the young (MODY) stands out as a prevalent monogenic diabetes subtype frequently encountered in clinical practice. Each subtype of MODY requires a distinct approach tailored to the pregnancy, diverging from management strategies in non-pregnant individuals. Glucokinase MODY (GCK-MODY) typically does not require treatment outside of pregnancy, but special considerations arise when a woman with GCK-MODY becomes pregnant. The glycemic targets in GCK-MODY pregnancies are not exclusively dictated by the maternal/paternal MODY genotype but are also influenced by the genotype of the developing fetus. During pregnancy, the choice between sulfonylurea or insulin for treating hepatocyte nuclear factor 1-alpha (HNF1A)-MODY and HNF4A-MODY depends on the mother's specific circumstances and the available expertise. Management of other rarer MODY subtypes is individualized, with decisions made on a case-by-case basis. Therefore, a collaborative approach involving expert diabetes and obstetric teams is crucial for the comprehensive management of MODY pregnancies.

Keywords:
DiabetesGlucokinaseHepatocyte nuclear factor 1-alpha, hepatocyte nuclear factor 1-beta, and hepatocyte nuclear factor 4-alphaInsulinMaturity-onset diabetes of the youngPregnancySulphonylurea

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