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Pre-existing diabetes mellitus in pregnancy — Clinical Guidelines

Overview

Pre-existing diabetes mellitus in pregnancy, also known as pregestational diabetes mellitus (PGDM), is associated with increased risks for both maternal and fetal adverse outcomes 7 10 11. These risks include preeclampsia, congenital anomalies, stillbirth, macrosomia, and birth trauma 10 11.

Diagnosis

Management

Dietitian involvement during prenatal care is associated with a lower prevalence of low birth weight and preterm infants 1.

Metformin prescription during pregnancy was not associated with an altered risk of any hypertensive disorder of pregnancy in nulliparous women with gestational diabetes or type 2 diabetes 2.

Oral L-arginine supplementation in women with a history of poor pregnancy outcomes or at high risk of pre-eclampsia may reduce risks of intrauterine growth retardation, preterm birth, and respiratory distress syndrome, and increase birthweight and gestational age 9. L-arginine also increased Apgar scores in women at high risk of or with pre-eclampsia or hypertension 9.

Special Populations

Pregnancy:

* Suboptimal medication adherence in pregnant women with chronic diseases like diabetes can adversely affect maternal and perinatal outcomes 5. * Interventions to enhance pre-pregnancy care for women with type 2 diabetes have shown limited impact on uptake, though pregnancy preparation indicators generally improved 4. * Elevated inflammation during pregnancy, influenced by dietary patterns (e.g., higher animal protein/cholesterol, lower fiber), is associated with adverse pregnancy outcomes 6. * Artificial intelligence and machine learning methods are being explored to improve pregnancy outcomes, particularly in prenatal and perinatal care 8.

Key Recommendations

Dietitian involvement during prenatal care is associated with improved birth outcomes, including a lower prevalence of low birth weight and preterm infants 1. (Evidence: Moderate)

Oral L-arginine may be recommended for women with a history of poor pregnancy outcomes and at high risk of or with pre-eclampsia or hypertension, as it has shown benefits for several adverse birth outcomes 9. (Evidence: Moderate)

Metformin use in pregnant women with gestational diabetes or type 2 diabetes was not associated with an increased risk of hypertensive disorders of pregnancy 2. (Evidence: Moderate)

References

1 Hanifi M., Liu W., Twynstra J., Seabrook J.A.. Does Dietitian Involvement During Pregnancy Improve Birth Outcomes? A Systematic Review. Canadian journal of dietetic practice and research : a publication of Dietitians of Canada = Revue canadienne de la pratique et de la recherche en dietetique : une publication des Dietetistes du Canada 2024. link 2 Gordon H, Salim N, Tong S, Walker S, De Silva M, Cluver C et al.. Metformin use and preeclampsia risk in women with diabetes: a two-country cohort analysis. BMC medicine 2024. link 3 Xu X, Du Y, Wang N. Association Between Circulating Resistin Level and Preeclampsia: A Meta-Analysis. Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme 2023. link 4 Hopkins L, Forbes A, Anderson JE, Bick D, Brackenridge A, Banerjee A et al.. Interventions to enhance pre-pregnancy care for women with type 2 diabetes: A systematic review of the literature. Diabetic medicine : a journal of the British Diabetic Association 2023. link 5 Davies A, Mullin S, Chapman S, Barnard K, Bakhbakhi D, Ion R et al.. Interventions to enhance medication adherence in pregnancy- a systematic review. BMC pregnancy and childbirth 2023. link 6 Yeh KL, Kautz A, Lohse B, Groth SW. Associations between Dietary Patterns and Inflammatory Markers during Pregnancy: A Systematic Review. Nutrients 2021. link 7 Kgosidialwa O, Bogdanet D, Egan A, Newman C, O'Shea PM, Biesty L et al.. A systematic review on outcome reporting in randomised controlled trials assessing treatment interventions in pregnant women with pregestational diabetes. BJOG : an international journal of obstetrics and gynaecology 2021. link 8 Davidson L, Boland MR. Towards deep phenotyping pregnancy: a systematic review on artificial intelligence and machine learning methods to improve pregnancy outcomes. Briefings in bioinformatics 2021. link 9 Goto E. Effects of prenatal oral L-arginine on birth outcomes: a meta-analysis. Scientific reports 2021. link 10 Berger H, Gagnon R, Sermer M. Guideline No. 393-Diabetes in Pregnancy. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2019. link 11 Berger H, Gagnon R, Sermer M, Basso M, Bos H, Brown RN et al.. Diabetes in Pregnancy. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2016. link

Pre-existing diabetes mellitus in pregnancy