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Published by College of French Gynecologists and Obstetricians and French Society of Diabetology
This expert consensus provides guidelines for the management of pre-existing type 1 and type 2 diabetes before, during, and after pregnancy. It outlines glycemic targets, monitoring strategies, timing of delivery, and postpartum/neonatal care.
Key Takeaways
Women with any type of diabetes should achieve an HbA1c level of less than 6.5%. For women using continuous glucose monitoring (CGM), the recommended target range is 0.70-1.80g/L (3.9-10mmol/L) for at least 70% of the time.
Discontinue statin and potentially teratogenic antihypertensive treatments, replace them with pregnancy-compatible treatments, and start folic acid supplementation at 0.4mg per day.
Fasting blood glucose should be less than 0.95g/dL, postprandial blood glucose less than 1.20g/dL, and HbA1c less than 6%. Time in target range should be >70% for T1D and >90% for T2D.
An initial assessment of kidney function is recommended for screening for diabetic nephropathy before pregnancy or during the first trimester. Women should also be screened for diabetic retinopathy via quarterly ophthalmological monitoring.
An ultrasound should be performed between 36 and 37 weeks of gestation to assess fetal growth, guide the mode of delivery, and determine gestational age at birth.
Delivery should be considered between 37 and 38+6 weeks of gestation. A cesarean section is recommended if fetal weight is suspected to be greater than 4,500g.
Blood glucose targets during labor and delivery are 0.8g/L to 1.4g/L, managed preferably with rapid-acting insulin.
Reduce insulin doses in the immediate postpartum period for T1D. For T2D, reintroduce oral or injectable antidiabetics, using only metformin if the woman is breastfeeding.
Implement active measures to prevent hypoglycemia (thermoregulation, feeding within one hour). Begin blood glucose monitoring before the second feeding (no later than 4 hours after birth) and continue before each feeding every 3 hours for at least 24 hours.
Clinical Topic
Diabetes in Pregnancy
Target Patient Population
Women with pre-existing type 1 or type 2 diabetes who are planning pregnancy, are pregnant, or postpartum
Target Providers
Therapeutic Area
Endocrinology and ObstetricsGuideline Scope
Care Settings
Special Populations
Contraindications
Monitoring Guidance
Regular monitoring by a diabetes specialist and monthly monitoring by an obstetrician-gynecologist from the first trimester. Includes continuous glucose monitoring for T1D, quarterly ophthalmological screening for retinopathy, and early screening for diabetic nephropathy.
Difficulty
advanced
Learning Paths