[Preexisting diabetes: Expert consensus from the College of French Gynecologists and Obstetricians and from the French Society of Diabetology].
Published by College of French Gynecologists and Obstetricians and French Society of Diabetology
Summary
AI-generatedThis 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
- 1Preconception glycemic targets include an HbA1c < 6.5% and switching to pregnancy-compatible medications.
- 2Strict pregnancy targets demand fasting glucose < 0.95 g/dL, postprandial < 1.20 g/dL, and HbA1c < 6%.
- 3Continuous Glucose Monitoring (CGM) is highly recommended for T1D management preconception and throughout pregnancy.
- 4Delivery is generally targeted between 37 and 38+6 weeks, maintaining strict intrapartum glucose control (0.8-1.4 g/L).
- 5Neonatal hypoglycemia requires active prevention via early feeding, thermoregulation, and protocolized monitoring for at least 24 hours.
Key Recommendations
Preconception Care
- REC-01
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.
Treatment - REC-02
Discontinue statin and potentially teratogenic antihypertensive treatments, replace them with pregnancy-compatible treatments, and start folic acid supplementation at 0.4mg per day.
Prevention
Care During Pregnancy
- REC-03
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.
Treatment - REC-04
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.
Screening - REC-05
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.
Monitoring
Labor and Delivery
- REC-06
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.
Treatment - REC-07
Blood glucose targets during labor and delivery are 0.8g/L to 1.4g/L, managed preferably with rapid-acting insulin.
Treatment
Postpartum Management
- REC-08
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.
Treatment
Neonatal Care
- REC-09
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.
Prevention
Scope & Objectives
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
Patient Criteria & Setting
Therapeutic Area
Endocrinology and ObstetricsGuideline Scope
Care Settings
Special Populations
Safety & Contraindications
Contraindications
- Statins
- Teratogenic antihypertensive treatments
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.
Authors & Contributors
Guideline Features
Learning Context
Difficulty
advanced
Learning Paths