JCEM | July 2025 (online July 2025)
Jennifer A. Wyckoff (Chair), Annunziata Lapolla (Co-Chair), Bernadette D. Asias-Dinh, Linda A. Barbour, Florence M. Brown, Patrick M. Catalano, Rosa Corcoy, Gian Carlo Di Renzo, Nancy Drobycki, Alexandra Kautzky-Willer, M. Hassan Murad, Melanie Stephenson-Gray, Adam G. Tabák, Emily Weatherup, Chloe Zera. Naykky Singh-OspinaShape
A Systematic Review Supporting the Endocrine Society Clinical Practice Guidelines on the Management of Preexisting Diabetes in Pregnancy [LINK COMING; PLEASE LINK THIS WHOLE TITLE]
Question 1. Should a screening question about pregnancy intention vs. no screening question be used in every healthcare provider appointment for individuals with diabetes mellitus who have the possibility of becoming pregnant?
Recommendation 1
In individuals with diabetes mellitus 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 | ⊕OOO)
Technical remarks:
Question 2. Should contraception vs. no contraception be used in individuals with diabetes mellitus who have the possibility of becoming pregnant?
Recommendation 2
In individuals with diabetes mellitus who have the possibility of becoming pregnant, we suggest use of contraception when pregnancy is not desired. (2 | ⊕⊕OO)
Technical remarks:
Question 3. Should discontinuation of Glucagon-Like Peptide-1 Receptor Agonist (GLP-1RA) before pregnancy vs. GLP-1RA discontinuation between the start of pregnancy and the end of the first trimester be used in individuals with pre-existing type 2 diabetes?
Recommendation 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. (2 | ⊕OOO)
Technical remarks:
Question 4. Should insulin vs. insulin with the addition of metformin be used in pregnant individuals with pre-existing diabetes type 2?
Recommendation 4
In pregnant individuals with type 2 diabetes mellitus (T2DM) already on insulin, we suggest against routine addition of metformin. (2 | ⊕OOO)
Question 5. Should a carbohydrate restricted (<175 g per day) diet vs. usual diet (>175 g per day) during pregnancy be used in individuals with pre-existing diabetes mellitus (PDM)?
Recommendation 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. (2 | ⊕OOO)
Technical remarks:
Question 6. Should a continuous glucose monitor (CGM) vs. no CGM (self-monitoring blood glucose [SMBG] as standard of care) be used in pregnant individuals with type 2 diabetes mellitus (T2DM)?
Recommendation 6
In pregnant individuals with type 2 diabetes mellitus (T2DM), we suggest either continuous glucose monitor (CGM) or self-monitoring of blood glucose (SMBG). (2 | ⊕OOO)
Technical remarks:
Question 7. Should a single continuous glucose monitor (CGM) target < 140 mg/dl (7.8mmol/L) be used vs 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) in individuals with pre-existing diabetes mellitus (PDM) using CGM?
Recommendation 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) (2 | ⊕OOO)
Technical remarks:
Question 8. Should a hybrid closed loop pump (pump adjusting automatically based on continuous glucose monitor (CGM)) vs. insulin pump with CGM (without an algorithm) or multiple daily insulin injections with CGM be used in individuals with Type 1 diabetes mellitus (T1DM) who are pregnant?
Recommendation 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. (2 | ⊕OOO)
Technical remarks:
Question 9. Should early delivery based on risk assessment vs. expectant management be used in individuals with pre-existing diabetes mellitus (PDM)?
Recommendation 9
In individuals with pre-existing diabetes mellitus (PDM), we suggest early delivery based on risk assessment rather than expectant management. (2 | ⊕OOO)
Technical remarks:
Question 10. In postpartum individuals with pre-existing diabetes mellitus (PDM) (including those with pregnancy loss or termination), should postpartum endocrine care (comprehensive diabetes management), in addition to usual obstetric care vs. usual obstetric care be used?
Recommendation 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. (2 | ⊕OOO)
Technical remark: