To provide recommendations for the care of individuals with preexisting diabetes (PDM) to reduce maternal and neonatal adverse outcomes, including specific risks such as congenital malformations and other complications.
Key Findings:
Preconception care (PCC) is crucial for reducing risks of congenital malformations and adverse pregnancy outcomes, supported by strong evidence.
Contraception is recommended when pregnancy is not desired to improve glycemic control and prevent unplanned pregnancies.
Discontinuation of GLP-1RA before conception is suggested due to limited data on risks during pregnancy.
Routine addition of metformin in pregnant individuals with T2DM already on insulin is not recommended due to potential risks.
Continuous glucose monitoring (CGM) or self-monitoring of blood glucose (SMBG) is suggested for pregnant individuals with T2DM to improve glycemic control.
Early delivery based on risk assessment is recommended rather than expectant management to mitigate risks.
Interpretation:
The guidelines emphasize the importance of managing diabetes effectively before and during pregnancy to improve outcomes, highlighting the need for PCC and the use of technology, such as CGM, in monitoring and managing diabetes.
Limitations:
The data supporting these recommendations were of very low to low certainty, indicating a need for more robust studies.
There is a need for further research to provide high certainty evidence for the care of individuals with diabetes during pregnancy, particularly in areas like dietary recommendations and medication safety.
Conclusion:
The guidelines provide a framework for improving care and outcomes for individuals with preexisting diabetes during pregnancy, stressing the importance of PCC and individualized management strategies.
by Jennifer A Wyckoff, Annunziata Lapolla, Bernadette D Asias-Dinh, Linda A Barbour, Florence M Brown, Patrick M Catalano, Rosa Corcoy, Gian Carlo Di Renzo, Nancy Drobycki, Alexandra Kautzky-Willer, M Hassan Murad, Melanie Stephenson-Gray, Adam G Tabák, Emily Weatherup, Chloe Zera, Naykky Singh-Ospina
