Epidemiology and Therapeutic Strategies for Women With Preexisting Diabetes in Pregnancy: How Far Have We Come? The 2021 Norbert Freinkel Award Lecture

Abstract

The field of diabetes in pregnancy has witnessed tremendous changes over the past 30 years, with an explosive growth in case numbers along with new and exciting opportunities to affect outcomes. Type 1 diabetes in pregnancy has increased by 40%, but type 2 diabetes in pregnancy, rarely seen 30 years ago, has more than doubled and, in some cases, tripled in prevalence. Compared with women with type 2 diabetes, women with type 1 diabetes have higher HbA1c, more large-for-gestational-age infants, and more preterm births. Women with type 2 diabetes have more chronic hypertension, more socioeconomic deprivation, and higher rates of perinatal mortality. Large randomized trials in women with diabetes in pregnancy have helped us understand the effectiveness of new technologies (i.e., continuous glucose monitoring) in women with type 1 diabetes, and the addition of metformin to insulin in women with type 2 diabetes, in improving pregnancy outcomes. Future endeavors, including artificial pancreas systems in women with type 1 diabetes and the use of continuous glucose monitoring, a better understanding of nutrition during pregnancy, and approaches to improve preconception and pregnancy self-care in women with type 2 diabetes, may lead to further improved outcomes.

Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis

“…These aforementioned variables that contribute to the complexity of CSII use may ultimately contribute to fetal hyperinsulinemia, overgrowth, and resultant LGA compared to MDI users. 28,[69][70][71] However, the available data do not elucidate the relative contributions of these challenges with CSII therapy to the greater risk of LGA. Similarly, the available data do not account for the contribution of these complex CSII variables to fetal hyperinsulinemia and associated neonatal hypoglycemia risk in those who initiate CGM prior to pregnancy.…”