Optimizing Diabetes-in-Pregnancy Outcomes Requires a Care Continuum

Area of Science:

• Obstetrics and Gynecology
• Endocrinology
• Public Health

Background:

• Historically, pregnancy for women with type 1 diabetes mellitus (T1DM) was associated with extremely high maternal and fetal mortality rates.
• The advent of insulin therapy and improved clinical management significantly reduced mortality, enabling successful pregnancies.
• However, recent increases in obesity and subsequent rises in type 2 and gestational diabetes mellitus, alongside rising T1DM rates, are reversing these gains.

Purpose of the Study:

• To assess the strengths, limitations, opportunities, and threats associated with diabetes in pregnancy.
• To review historical improvements and evaluate current challenges in maternal and fetal outcomes.
• To identify opportunities for preventing increased mortality and adverse outcomes related to diabetes during pregnancy.

Main Methods:

• Review of historical data on maternal and fetal mortality rates.
• Analysis of current trends in diabetes prevalence, including type 1, type 2, and gestational diabetes mellitus.
• Evaluation of the impact of the global obesity epidemic on diabetes in pregnancy.
• Synthesis of opportunities for research and clinical interventions.

Main Results:

• Maternal survival rates for T1DM increased from 54% to 97% after insulin therapy.
• The global obesity epidemic is driving an increase in type 2 and gestational diabetes mellitus.
• Rising prevalence of pregestational diabetes mellitus (T1DM, T2DM) is increasing risks for adverse pregnancy outcomes.
• Existing gains in reducing adverse outcomes are being eroded by contemporary challenges.

Conclusions:

• Effective management of overweight, obesity, and diabetes is essential prior to conception.
• Preconception counseling and education are critical for individuals with diabetes planning pregnancy.
• A multidisciplinary approach involving Ob/Gyns, primary care physicians, nutritionists, and weight management specialists is necessary.
• Further research is needed to address inequities and improve outcomes in diabetes in pregnancy.