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Just published July 13th, 2025 -The Endocrine Society and European Society of Endocrinology’s newest guideline on Pre Existing Diabetes (PDM) and Pregnancy

The objective of this guideline is to provide recommendations for the care of individuals with PDM that lead to a reduction in maternal and neonatal adverse outcomes.

There are 10 recommendations, so let’s get started

  • In individuals with diabetes who have the possibility of becoming pregnant, the guideline 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.
  • In individuals with diabetes mellitus who have the possibility of becoming pregnant, the guideline suggests use of contraception when pregnancy is not desired.
  • In individuals with type 2 diabetes, the guideline 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.
  • In pregnant individuals with pre-existing diabetes mellitus (PDM) already on insulin, the guideline suggests against routine addition of metformin.
  • In individuals with PDM, the guideline suggests either a carbohydrate restricted diet (<175 g per day) or usual diet (>175 g per day) during pregnancy.
  • In pregnant individuals with type 2 diabetes, the guideline suggests either continuous glucose monitor (CGM) or self-monitoring of blood glucose (SMBG).
  • In individuals with (PDM) using a CGM, the guideline suggests against the use of single 24 hour CGM target < 140 mg/dl in place of standard of care pregnancy glucose targets of fasting <95 mg/dl , 1hr. post prandial <140 mg/dl, 2hr post prandial < 120 md/dl 
  • In individuals with Type 1 diabetes mellitus (T1DM) who are pregnant, the guideline suggests the use of a hybrid closed loop pump rather than an insulin pump with CGM (without an algorithm) or multiple daily insulin injections with CGM.
  • In individuals with (PDM), the guideline suggests early delivery based on risk assessment rather than expectant management.
  • In individuals with pre-existing diabetes , the guideline suggests post-partum endocrine care, in addition to usual obstetric care.

And there you have it. Make sure to check out the full guideline from The Endocrine Society and European Society of Endocrinology  and other related clinical decision support tools at guidelinecentral.com.

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