Management of type 2 diabetes in pregnancy: a narrative review

Raets, Lore; Ingelbrecht, Anne; Benhalima, Katrien

doi:10.3389/fendo.2023.1193271

Cited by 8 publications

(5 citation statements)

References 115 publications

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“…Conclusively, the findings of the EXPECT study were reassuring for the use of IDeg in diabetic women who are pregnant or are planning to become pregnant, since detemir has been well studied and is considered effective and safe in this setting. Its administration has been recently approved for pregestational diabetes in the USA, Canada and Europe [ 37 , 38 ]. The main results of current clinical studies, which explored the role of IDeg in pregestational diabetes, are shown in Table I .…”

Section: Clinical Evidencementioning

confidence: 99%

Insulin degludec in pregestational diabetes: evidence and perspectives

Papaetis,

Mikellidis

2024

Arch Med Sci Atheroscler Dis

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Pregestational diabetes is described when a woman with diabetes before the onset of pregnancy becomes pregnant and consequently she is vulnerable to higher risk for adverse outcomes in the embryo/foetus. Strict glycaemic control, with minimal glucose variability, starting from before conception and maintained throughout pregnancy decreases significantly adverse foetal and maternal outcomes; maternal hypoglycaemic episodes are the major barrier in achieving this goal. Insulin degludec is an ultralong-acting analogue, which has half-life of over 25 h and full duration of effect of more than 42 h, reaching a steady-state serum concentration after 2–3 days of its administration. It promotes flat, steady, peakless and predictable insulin concentrations, with minor intra-individual and inter-individual variability. It also exerts a low mitogenic/metabolic potency ratio. This review examines thoroughly all current evidence of the administration of insulin degludec in pregestational diabetes as well as its future role in this population.

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Section: Clinical Evidencementioning

confidence: 99%

Insulin degludec in pregestational diabetes: evidence and perspectives

Papaetis,

Mikellidis

2024

Arch Med Sci Atheroscler Dis

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“…Although the weights of infants of diabetic mothers are generally skewed Biomedicines 2024, 12, 1372 2 of 17 into the upper range, intrauterine growth restriction (IUGR), commonly diagnosed as low birth weight, occurs with concerning frequency in diabetic women, especially those with underlying hypertension, uncontrolled blood glucose levels, and vascular diseases [11,12]. T2DM has been shown to account for 30-50% of cases of pregestational diabetes during pregnancy [13].…”

Section: Introductionmentioning

confidence: 99%

A Review of Fetal Development in Pregnancies with Maternal Type 2 Diabetes Mellitus (T2DM)-Associated Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysregulation: Possible Links to Pregestational Prediabetes

Ngema,

Xulu,

Ngubane

et al. 2024

Biomedicines

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Research has identified fetal risk factors for adult diseases, forming the basis for the Developmental Origins of Health and Disease (DOHaD) hypothesis. DOHaD suggests that maternal insults during pregnancy cause structural and functional changes in fetal organs, increasing the risk of chronic diseases like type 2 diabetes mellitus (T2DM) in adulthood. It is proposed that altered maternal physiology, such as increased glucocorticoid (GC) levels associated with a dysregulated hypothalamic-pituitary-adrenal (HPA) axis in maternal stress and T2DM during pregnancy, exposes the fetus to excess GC. Prenatal glucocorticoid exposure reduces fetal growth and programs the fetal HPA axis, permanently altering its activity into adulthood. This programmed HPA axis is linked to increased risks of hypertension, cardiovascular diseases, and mental disorders in adulthood. With the global rise in T2DM, particularly among young adults of reproductive age, it is crucial to prevent its onset. T2DM is often preceded by a prediabetic state, a condition that does not show any symptoms, causing many to unknowingly progress to T2DM. Studying prediabetes is essential, as it is a reversible stage that may help prevent T2DM-related pregnancy complications. The existing literature focuses on HPA axis dysregulation in T2DM pregnancies and its link to fetal programming. However, the effects of prediabetes on HPA axis function, specifically glucocorticoid in pregnancy and fetal outcomes, are not well understood. This review consolidates research on T2DM during pregnancy, its impact on fetal programming via the HPA axis, and possible links with pregestational prediabetes.

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“…Type 2 diabetes in pregnancy is increasing, accounting for 30-50% of pregestational diabetes, and it is related to worse maternal and fetal outcomes. As for mothers' complications, women affected by type 2 diabetes in pregnancies are at a higher risk of miscarriage, pre-eclampsia, gestational hypertension, cesarean delivery, and pre-term delivery [15,16]. Neonates of women with type 2 diabetes are at higher risk of LGA, birth trauma, respiratory distress, hypoglycemia, hyperbilirubinemia, hypocalcemia, and congenital malformations [15,16].…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Analysis of the Outcomes of Pregnancies in Women Affected by Overt Diabetes Compared to Women Affected by Pre-Existing Type 2 Diabetes

Dalfrà,

Burlina,

Fioretti

et al. 2024

Endocrines

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Background: Pregestational diabetes mellitus, if not well controlled, determines maternal and fetal complications. According to the new diagnostic criteria for gestational diabetes, the diagnosis of diabetes mellitus can also occur in early pregnancy (overt diabetes). Aim: This study aims to determine pregnancy outcomes in women with overt diabetes compared to women with pre-existing type 2 diabetes. Methods: In this retrospective study, we selected women with pre-existing type 2 and overt diabetes who had at least one pregnancy in the 2010–2022 period at the Diabetic Care Unit of Padova. Results: We analyzed 83 pregnancies, and overt diabetes was diagnosed in 18 pregnancies. In total, 95.5% of patients with overt diabetes and 48% of T2DM patients were immigrants (p < 0.143). No patients with overt diabetes planned their pregnancy, while pregnancy was planned in 26.3% of patients with pre-exiting type 2 diabetes (p < 0.05). Periconception and first-trimester glycemic control were the worst in patients with overt diabetes (HbA1c 9.7 ± 3.1% vs. 7.3% ± 2.3%, p < 0.044, at first visit; 8.1 ± 1.9% and 7.0 ± 1.6%, p < 0.037 in the first trimester) with respect to patients with pre-existing type 2 diabetes. As for maternal outcomes, 16.6% of pregnancies ended in miscarriage, and 5.5% of women developed gestational hypertension; as for newborn outcomes, 16.6% of newborns were LGA, and 11.1% were affected by congenital anomalies without any significant difference with respect to women with pre-existing type 2 diabetes. The high rate of congenital malformations in pregnancies of women with overt diabetes is probably a result of the poor, metabolic control observed during the periconception period when the organogenesis of the fetus takes place. Conclusions: It is essential to utilize procedures for diabetes screening in women of childbearing age not only at the beginning of the pregnancy, but also during the preconception phase or the postmenarcheal period when strong risk factors for diabetes onset are present, such as a high BMI, glycemic disorders, and those who fall under high-risk ethnicity categories.

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Management of type 2 diabetes in pregnancy: a narrative review

Cited by 8 publications

References 115 publications

Insulin degludec in pregestational diabetes: evidence and perspectives

Insulin degludec in pregestational diabetes: evidence and perspectives

A Review of Fetal Development in Pregnancies with Maternal Type 2 Diabetes Mellitus (T2DM)-Associated Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysregulation: Possible Links to Pregestational Prediabetes

A Retrospective Analysis of the Outcomes of Pregnancies in Women Affected by Overt Diabetes Compared to Women Affected by Pre-Existing Type 2 Diabetes

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