Addressing the social determinants of adverse outcomes in pregestational diabetes

Diabetes is among the most prevalent chronic diseases worldwide, with incidence rising each year, shaped by social inequities which influence both vulnerability to disease and access to quality care. These inequities and their systemic drivers are collectively termed the Social Determinants of Health (SDOH). Pregnancy introduces additional physiological and social challenges that can intensify existing inequities. For individuals with diabetes, pregnancy can compound adverse SDOH, increasing both risks and disparities in perinatal outcomes. To effectively manage pregestational diabetes, healthcare professionals must expand their clinical knowledge to understand impact of SDOH, and systematically screen and refer to relevant social support programs. The root causes of SDOH lie in the systems and policies; engaging in advocacy is only way to enact systemic change and complements any individual-level efforts. This review aims to improve adverse perinatal outcomes by providing practical clinical tools to address SDOH in pregestational diabetes in European context.