In today's Guidelines Side-by-Side, we look at the latest clinical practice guidelines from the Endocrine Society (ES) and the American Diabetes Association (ADA) on preexisting diabetes and pregnancy side-by-side.
In July, ES (in a joint release with the European Society of Endocrinology) released Preexisting Diabetes and Pregnancy, a clinical practice guideline. To compare the latest from the ES, we selected the ADA's annual, Standards of Care in Diabetes, opting for the latest version, 2025 (published in late 2024).
Guidelines for Comparison
| Authoring Organization | Endocrine Society | American Diabetes Association |
|---|---|---|
| Publication Date | July 13, 2025 | December 9, 2024 |
| Graded Recommendations | Yes | Yes |
| Summary Link | Summary | Summary |
| Full Text Link | Full Text | Full Text |
Key Takeaways
- The ES guideline focuses exclusively on the care of individuals with preexisting diabetes before, during, and after pregnancy, offering targeted recommendations on topics such as blood glucose management, nutrition, and medication use. In contrast, the ADA guideline is a living guideline and is updated annually, encompassing all aspects of diabetes management across the lifespan.
- While both guidelines emphasize the importance of glycemic control and preconception planning, the ES provides more detailed, preexisting diabetes and pregnancy-specific guidance, whereas the ADA addresses these topics as part of its broader, lifespan-based approach to diabetes care.
Comparison of Recommendations
| Topic | Endocrine Society | American Diabetes Association |
|---|---|---|
| Preconception Screening and Planning | In individuals with diabetes mellitus who have the possibility of becoming pregnant, ES suggests asking a screening question about pregnancy intention at every reproductive, diabetes and primary care visit. Screening for pregnancy intent should also be addressed at urgent care/emergency room visits when clinically appropriate. | Starting at puberty and continuing in all people with diabetes and childbearing potential, preconception counseling should be incorporated into routine diabetes care. Individuals with preexisting diabetes who are planning a pregnancy should ideally begin receiving interprofessional care for preconception, which includes an endocrinology health care professional, maternal-fetal medicine specialist, registered dietitian nutritionist, and diabetes care and education specialist, when available. A person-centered shared decision-making approach to preconception planning is essential for all individuals with diabetes and of childbearing potential. Preconception planning should address attainment of glycemic goals, the time frame for discontinuing noninsulin glucose-lowering medications, and optimal glycemic management in preparation for pregnancy. |
| Family Planning & Contraception | In individuals with diabetes mellitus who have the possibility of becoming pregnant, ES suggests use of contraception when pregnancy is not desired. | Family planning should be discussed, and effective contraception (with consideration of long-acting, reversible contraception) should be prescribed and used until an individual’s treatment plan and A1C are optimized for pregnancy. |
| GLP-1 Receptor Agonist | In individuals with type 2 diabetes mellitus, ES suggests discontinuation of Glucagon-Like Peptide-1 Receptor Agonist (GLP-1RA) before conception rather than discontinuation between the start of pregnancy and the end of the first trimester. | Not addressed. |
| Nutrition | In individuals with preexisting diabetes, ES suggests either a carbohydrate restricted diet (<175 g per day) or usual diet (>175 g per day) during pregnancy. | Not addressed. |
| Metformin | In pregnant individuals with type 2 diabetes mellitus already on insulin, ES suggests against routine addition of metformin. | Metformin and glyburide, individually or in combination, should not be used as first-line agents for management of diabetes in pregnancy, as both cross the placenta to the fetus and may not be sufficient to achieve glycemic goals. Other oral and noninsulin injectable glucose-lowering medications lack long-term safety data and are not recommended. |
| Continuous Glucose Monitors & Glucose Monitoring | In pregnant individuals with T2DM, ES suggests either continuous glucose monitor (CGM) or self-monitoring of blood glucose (SMBG). In individuals with preexisting diabetes using a CGM, ES suggests against the use of single 24 hour CGM target <140 mg/dl (7.8 mmol/L) in place of standard of care pregnancy glucose targets of fasting <95 mg/dl (5.3 mmol/L), 1 hr. post prandial <140 mg/dl (7.8 mmol/L), 2 hr post prandial <120 md/dl (6.7 mmol/L). | Continuous glucose monitoring (CGM) can help to achieve glycemic goals (e.g., time in range, time above range) and A1C goal in type 1 diabetes and pregnancy and may be beneficial for other types of diabetes in pregnancy. Fasting, preprandial, and postprandial blood glucose monitoring are recommended in individuals with diabetes in pregnancy to achieve optimal glucose levels. Glucose goals are fasting plasma glucose <95 mg/dL (<5.3 mmol/L) and either 1-h postprandial glucose <140 mg/dL (<7.8 mmol/L) or 2-h postprandial glucose <120 mg/dL (<6.7 mmol/L). |
| Insulin Pumps | In individuals with T1DM who are pregnant, ES suggests the use of a hybrid closed loop pump (pump adjusting automatically based on CGM) rather than an insulin pump with CGM (without an algorithm) or multiple daily insulin injections with CGM. | Either multiple daily injections or insulin pump technology can be used in pregnancy complicated by type 1 diabetes. Consider combining technology (CGM, insulin pump, and/or diabetes apps) with online or virtual coaching to improve glycemic outcomes in individuals with diabetes or prediabetes. |
| Retinopathy Screening | Not addressed. | Counsel individuals of childbearing potential with preexisting type 1 or type 2 diabetes who are planning pregnancy or who are pregnant on the risk of development and/or progression of diabetic retinopathy. Individuals with preexisting type 1 or type 2 diabetes should receive an eye exam before pregnancy as well as in the first trimester and may need to be monitored every trimester and for 1 year postpartum as indicated by the degree of retinopathy. |
| Early Delivery | In individuals with preexisting diabetes, ES suggests early delivery based on risk assessment rather than expectant management. | Not addressed. |
| Postpartum Care | In individuals with pre-existing diabetes (including those with pregnancy loss or termination), ES suggests postpartum endocrine care (diabetes management), in addition to usual obstetric care. | Not addressed. |
That concludes our Guidelines Side-by-Side on preexisting diabetes and pregnancy. Sign up for alerts to keep up with the latest approved clinical guideline releases and updates.
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