The Endocrine Society just released new clinical practice guidelines, Pre-Existing Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guideline. Together, the two societies collaborated to create guidelines that provide recommendations for people with pre-existing diabetes in an effort to reduce adverse outcomes for maternal and neonatal patients.

These guidelines are broken down into 10 key recommendations, each accompanied by technical remarks that further support the recommendations with additional insight. The recommendations cover topics related to GLP-1RAs, dietary adjustments, glucose monitoring, and more.

For your convenience, we’ve highlighted the key recommendations below. 

Ten Key Recommendations from the Guidelines:
  1. In individuals with diabetes who have the possibility of becoming pregnant, we suggest 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.
  2. In individuals with diabetes mellitus who have the possibility of becoming pregnant, we suggest use of contraception when pregnancy is not desired.
  3. In individuals with type 2 diabetes, we suggest 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.
  4. In pregnant individuals with pre-existing diabetes mellitus (PDM) already on insulin, we suggest against routine addition of metformin.
  5. In individuals with pre-existing diabetes mellitus (PDM), we suggest either a carbohydrate restricted diet (<175 g per day) or usual diet (>175 g per day) during pregnancy.
  6. In pregnant individuals with type 2 diabetes mellitus (T2DM), we suggest either continuous glucose monitor (CGM) or self-monitoring of blood glucose (SMBG).
  7. In individuals with pre-existing diabetes mellitus (PDM) using a continuous glucose monitor (CGM), we suggest against the use of single 24 hour continuous glucose monitor (CGM) target < 140 mg/dl (7.8mmol/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), 2hr post prandial < 120 md/dl (6.7mmol/L).
  8. In individuals with Type 1 diabetes mellitus (T1DM) who are pregnant, we suggest the use of a hybrid closed loop pump (pump adjusting automatically based on continuous glucose monitor (CGM)) rather than an insulin pump with CGM (without an algorithm) or multiple daily insulin injections with CGM.
  9. In individuals with pre-existing diabetes mellitus (PDM), we suggest early delivery based on risk assessment rather than expectant management
  10. In individuals with pre-existing diabetes (including those with pregnancy loss or termination), we suggest post-partum endocrine care (diabetes management), in addition to usual obstetric care.

These guidelines are set to be reviewed annually to assess existing recommendations and updated evidence. If warranted, updates will then be made.

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