A Systematic Review Supporting the Clinical Practice Guidelines on the Management of Preexisting Diabetes and Pregnancy

Jul 13, 2025The Journal of clinical endocrinology and metabolism

Review Supporting Guidelines for Managing Diabetes During Pregnancy

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Abstract

Meta-analysis of 17 studies found no significant difference in time in range between hybrid closed-loop insulin pumps and standard care.

Hybrid closed-loop insulin pumps improved overnight time in range and time below range compared to standard care.
Intermittent use of continuous glucose monitoring did not significantly change the risk of large for gestational age neonates in women with type 2 diabetes.
Adding metformin to insulin was linked to a lower risk of large for gestational age neonates.
Evidence from three retrospective studies suggested increased neonatal complications when delivery was induced before 39 weeks of gestation in women with preexisting diabetes.
Periconceptional exposure to glucagon-like peptide-1 receptor agonists showed no increase in neonatal complications.

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CONTEXT: Women with preexisting diabetes mellitus (PDM) are at increased risk of pregnancy-related complications.

OBJECTIVE: To summarize the available supporting evidence for the Endocrine Society guidelines about management of PDM in pregnancy.

DATA SOURCES: MEDLINE, EMBASE, Scopus, and other sources through February 2025.

STUDY SELECTION: Studies were selected by pairs of independent reviewers.

DATA EXTRACTION: Data were extracted by pairs of independent reviewers.

DATA SYNTHESIS: We included 17 studies. Meta-analysis showed no significant difference between hybrid closed-loop insulin pump (HCL) and standard of care regarding time in range (TIR), time above range (TAR), and time below range (TBR). HCL had better overnight TIR and TBR. For women with type 2 diabetes mellitus (T2DM), intermittent use of continuous glucose monitoring (CGM) was not associated with a significant change in the risk of large for gestational age (LGA) neonates (2 randomized controlled trials [RCTs], 102 patients). Adding metformin to insulin was associated with a lower risk of LGA (2 RCTs, 1126 patients). Three retrospective studies (1724 patients) suggested increased neonatal complications when delivery was induced before 39 weeks of gestation (particularly before 38 weeks) in women with preexisting type 1 (T1DM) and T2DM, although this evidence was subject to likely confounding. One retrospective study showed no increase in neonatal complications with periconceptional exposure to glucagon-like peptide-1 receptor agonists. We could not identify comparative studies assessing a screening question about the possibility of pregnancy or a carbohydrate restrictive diet.

CONCLUSION: This systematic review addresses various aspects of managing PDM in pregnancy and will support the development of the Endocrine Society guidelines.

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A Systematic Review Supporting the Clinical Practice Guidelines on the Management of Preexisting Diabetes and Pregnancy

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