Optimizing Diabetes-in-Pregnancy Outcomes Requires a Care Continuum

Audrey M. Huang; Menachem Miodovnik; E. Albert Reece

doi:10.1055/a-2505-5330

American Journal of Perinatology, Table of Contents

Am J Perinatol 2025; 42(13): 1704-1713
DOI: 10.1055/a-2505-5330

Review Article

Optimizing Diabetes-in-Pregnancy Outcomes Requires a Care Continuum

Authors

Audrey M. Huang

¹Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Advanced Research Training and Innovation, University of Maryland School of Medicine, Baltimore, Maryland
Menachem Miodovnik

²Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Inova Health System, Falls Church, Virginia
E. Albert Reece

³Center for Advanced Research Training and Innovation, Center for Birth Defects Research, University of Maryland School of Medicine, Baltimore, Maryland

Abstract

This study aimed to assess the strengths, limitations, opportunities, and threats presented by diabetes-in-pregnancy. We review the improvements in maternal and fetal mortality since the advent of insulin therapy, evaluate current health challenges, and identify opportunities for preventing increased mortality due to diabetes-in-pregnancy. Prior to 1922, women with type 1 diabetes mellitus (T1DM) of childbearing age were discouraged from becoming pregnant as the maternal and fetal/neonatal mortality rates were extremely high. Starvation-level dietary restriction was the only “treatment,” with limited success in managing the disease. The discovery of insulin coupled with careful clinical management presented the possibility of successful pregnancies for women with T1dm. Over the course of the next half-century, maternal survival increased from 54 to 97%. However, the gains made in reducing adverse outcomes of diabetes in pregnancy are eroding due to modern challenges. The global obesity epidemic has led to an increase in type 2 and gestational diabetes mellitus (DM). T1DM also is on the rise. Together, the rise in the prevalence of pregestational diabetes has increased the risks for adverse outcomes. Here we review the ongoing challenges as well as opportunities for research to improve outcomes. We suggest that overweight, obesity, and diabetes management must be coupled with preconception counseling and education and must include, in addition to, Ob/Gyns, primary care, nutrition, weight management, and other experts to ensure that those at risk of pregnancy complications due to diabetes have the best possible outcomes.

Key Points

Diabetes in pregnancy is affecting more people.
The obesity epidemic is fueling an increase in pregestational diabetes.
Research is needed to reduce inequities in diabetes in pregnancy outcomes.
Blood glucose control should start prior to pregnancy.

Keywords

diabetes mellitus - pregestational diabetes - pregnancy complications - maternal obesity - pregnancy in diabetics - preconception counseling - glycemic control

Full Text

References

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