Preexisting Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guideline

In individuals with DM who may become pregnant, ask a screening question about pregnancy intention at every reproductive, diabetes and primary care visit; also at urgent care/ED visits when clinically appropriate.

In individuals with DM who may become pregnant, use contraception when pregnancy is not desired.

In T2DM, discontinue GLP-1 RA before conception rather than between the start of pregnancy and the end of the first trimester.

In pregnant individuals with T2DM already on insulin, suggest against routine addition of metformin.

In PDM, either a carbohydrate-restricted diet (<175 g/day) or usual diet (>175 g/day) during pregnancy.

In pregnant individuals with T2DM, either continuous glucose monitor (CGM) or self-monitoring of blood glucose (SMBG).

In PDM using CGM, suggest against a single 24-hour CGM target <140 mg/dL (7.8 mmol/L) in place of standard-of-care pregnancy glucose targets (fasting <95 mg/dL [5.3 mmol/L], 1-hour postprandial <140 mg/dL [7.8 mmol/L], 2-hour postprandial < 120 mg/dL [6.7 mmol/L]).

In pregnant individuals with T1DM, hybrid closed-loop pump rather than insulin pump with CGM (without algorithm) or MDI with CGM; meta-analysis of randomized controlled trials (RCTs): time in range MD +3.81% (CI −4.24 to 11.86), time below range MD −0.85% (CI −1.98 to 0.28).

In PDM, early delivery based on risk assessment rather than expectant management.

In PDM (including pregnancy loss or termination), postpartum endocrine care (diabetes management) in addition to usual obstetric care.