Joint Guideline Recommends Preconception Care for Women with Diabetes

Strategic Insights -

A joint guideline released by the Endocrine Society and the European Society of Endocrinology recommends women with diabetes receive proper preconception care to manage their blood sugar before, during, and after pregnancy. The guideline suggests key recommendations, including screening women with diabetes for intent to conceive at every doctor visit, discontinuing anti-obesity medications called GLP-1s prior to pregnancy, and avoiding prescribing metformin in pregnant individuals with preexisting diabetes already on insulin. Additionally, the guideline recommends hybrid closed-loop systems for pregnant individuals with type 1 diabetes and suggests women with diabetes use contraception until they are ready to become pregnant.

Key Takeaways:

  • The joint guideline recommends women with diabetes receive proper preconception care and access to emerging diabetes technology and therapeutics to manage their blood sugar before, during, and after pregnancy.
  • Screening women of reproductive age who have diabetes for intent to conceive at every reproductive, diabetes, and primary care visit helps ensure they get the appropriate preconception care and reduces health risks.
  • Delivery timing should be before 39 weeks for pregnant individuals with diabetes, as the risks associated with continued pregnancy may outweigh those of early delivery.
  • Anti-obesity medications called GLP-1s should be discontinued prior to pregnancy, and metformin should not be prescribed in pregnant individuals with preexisting diabetes already on insulin.
  • Hybrid closed-loop systems are recommended for pregnant individuals with type 1 diabetes.
  • Women with diabetes should use contraception until they are ready to become pregnant.
  • The guidelines highlight the need for research and investment into preconception care, more randomized control trials to define glycemic targets in pregnancy, and data on optimal nutrition and obesity management in pregnancy.
  • The guideline writing panel prioritized randomized controlled trials (RCTs) and used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology to assess the certainty of evidence and guide recommendations.
  • The recommendations address issues related to correct nutrition and therapeutic approach in women with type 2 diabetes and obesity.
  • The guideline development involved a multidisciplinary panel of topic-related experts in the field using a rigorous methodology, and all clinical practice guidelines are supported entirely by Society funds.

Statistics:

  • The joint guideline affects approximately 20 million women of reproductive age worldwide with diabetes.
  • The prevalence of diabetes among women of reproductive age is increasing globally, with a significant impact on health outcomes.
  • Adverse pregnancy outcomes, such as miscarriages or birth defects, are common in individuals with pre-existing diabetes and are often related to modifiable factors such as maternal high blood sugar and body mass index (BMI).
  • The risk of adverse pregnancy outcomes increases with gestational age, with a significant increase in risk after 39 weeks of gestation.
  • Hybrid closed-loop systems can improve glycemic control and reduce the risk of hypoglycemia in pregnant individuals with type 1 diabetes.

Sources:

  • "Preexisting Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guideline" (The Journal of Clinical Endocrinology & Metabolism and European Journal of Endocrinology)
  • Endocrine Society's Clinical Practice Guideline Program
  • Endocrine Society and European Society of Endocrinology joint statement
  • Endocrine Society press release