New guidelines stress preconception care for women with diabetes

Proper preconception care and access to emerging diabetes therapeutics should be provided to women with diabetes before, during, and after pregnancy, according to joint guidelines released by the Endocrine Society and the European Society of Endocrinology on July 13, 2025.¹

Screening at every visit to reduce health risks

According to the societies, health risks are reduced in reproductive aged women with diabetes through screening at every reproductive, diabetes, and primary care visit. This allows those intending to conceive to undergo proper preconception care, reducing the odds of adverse pregnancy outcomes linked to modifiable factors such as high blood sugar.¹

“We developed these guidelines as diabetes rates are rising among women of reproductive age and very few women with diabetes receive proper preconception care,” said Jennifer Wyckoff, MD, guideline chair from the University of Michigan. “In addition to preconception planning, the guideline discusses advances in diabetes technology, delivery timing, medications and diet.”¹

Preventing adverse outcomes

Outcomes that may prevented include miscarriages and birth defects. Alongside being published in The Journal of Clinical Endocrinology & Metabolism and the European Journal of Endocrinology, the guidelines were presented at ENDO 2025, the Endocrine Society’s annual meeting in San Francisco, California.¹

A multidisciplinary panel of topic-related experts developed the guidelines. These experts assessed evidence-based reviews when determining recommendations, and no corporate support was obtained. Insteady, Society funds were used to support development of the guidelines.¹

The guidelines highlighted recommendations for screening, delivery timing, medications, diabetes technology, and contraception. For screening, the guidelines suggest asking women about their intent to conceive at every reproductive, diabetes, and primary care visit.¹

Importance of preconception care

Authors noted outcomes such as congenital malformations or miscarriage have an exposure period beginning weeks before the pregnancy is identified.² This highlights the importance of preconception care to improve women’s health and well-being.

An example of pregnancy intention screening is the ONE KEY QUESTION. Patients indicating a desire to conceive may receive counseling and screenings to manage modifiable risk factors, while those who do not indicate this desire may be counselled about the full range of contraceptive options.²

Delivery timing should be considered to balance the risks and benefits of early delivery vs continued pregnancy.¹ According to the guidelines, delivery at 39-weeks’ gestation or later may be associated with greater risks in pregnant women with diabetes than delivery before 39 weeks.

Advances in diabetes management

Investigators recommended hybrid closed loop systems be used in pregnant individuals with type 1 diabetes. Pregnant women with diabetes who are taking insulin should also halt GLP-1 anti-obesity medication use before pregnancy, instead receiving metformin during this period.¹

Until they are ready for pregnancy, the guidelines also stated women with diabetes should be recommended contraception. However, authors noted a lower prevalence of contraception use among this population.Therefore, contraceptive counseling should be patient centered and involve shared decision making.²

Need for further research

Overall, the guidelines address management options for the increasingly growing population of patients with preexisting diabetes mellitus. These methods may be used to minimize maternal and neonatal risks, alongside maintaining healthy glycemia before and during pregnancy.²

“The guidelines highlight the need for research and investment into preconception care, more randomized control trials to define glycemic targets in pregnancy, and data on optimal nutrition and obesity management in pregnancy,” said Wyckoff.¹

References

1. Experts suggest screening women with diabetes for intent to conceive at every doctor visit. The Endocrine Society. July 13, 2025. Accessed July 14, 2025. https://www.eurekalert.org/news-releases/1090818.
2. Wyckoff JA, Lapolla A, Asias-Dinh BD, et al. Preexisting diabetes and pregnancy: An Endocrine Society and European Society of Endocrinology joint clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism. 2025. doi:10.1210/clinem/dgaf288