Ligne directrice

WHO recommendations on care for women with diabetes during pregnancy

Année de publication

2025

Institution émettrice

World Health Organization

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Recommandations

27 recommandations incluses

For pregnant women with type 1, type 2 or gestational diabetes, provide individualized advice on diet, physical activity and weight management based on existing WHO guidance, including: • dietary advice for the general adult population; • physical activity advice for the general pregnant population; • weight management advice based on the above dietary and physical activity advice, with a focus on appropriate gestational weight gain.

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Antenatal education. For pregnant women with type 1, type 2 or gestational diabetes, provide education on: • the effects of diabetes in pregnancy on maternal, fetal, newborn and child health outcomes; • diet and physical activity; • appropriate gestational weight gain; • managing glycaemia; • the need for additional monitoring of fetal growth and wellbeing

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Specialized care. For pregnant women with type 1 or type 2 diabetes, deliver multidisciplinary and specialized care provided by health-care providers trained in maternal and diabetes care.

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Specialized care. For women with gestational diabetes, consider multidisciplinary and specialized care provided by health-care providers trained in maternal and diabetes care, depending on access and availability

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Mode of glucose monitoring. For pregnant women with type 1, type 2 or gestational diabetes, recommend self-monitoring of blood glucose (SMBG) in addition to routine care, where feasible.

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Mode of glucose monitoring. For pregnant women with type 1 diabetes, recommend the use of a continuous glucose monitoring (CGM) system, where feasible

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Mode of glucose monitoring. For pregnant women with type 2 or gestational diabetes, do not routinely recommend use of a continuous glucose monitoring (CGM) system

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For pregnant women with type 1 or type 2 diabetes, measure glycated haemoglobin (HbA1c) in the first trimester or as soon as antenatal care is initiated

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For women with gestational diabetes, do not routinely measure glycated haemoglobin (HbA1c).

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For pregnant women with type 1, type 2 or gestational diabetes, individualize glycaemic targets to optimize glycaemic control and improve maternal and neonatal outcomes

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For pregnant women with type 1 diabetes, recommend continuation of the same type of insulin used before pregnancy unless a change is considered necessary to optimize blood glucose control and outcomes for the woman and baby

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For pregnant women with type 1 diabetes, recommend continuation of the method of insulin delivery used before pregnancy unless a change is considered necessary to optimize blood glucose control and outcomes for the woman and baby.

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For pregnant women with type 2 diabetes who are unable to maintain optimal blood glucose levels with diet and physical activity alone, recommend initiation of metformin or insulin to optimize blood glucose control and outcomes for the woman and baby.

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For pregnant women with type 2 diabetes who are receiving monotherapy with insulin or metformin and who are unable to achieve optimal blood glucose levels, consider initiation of a combination of metformin and insulin to optimize blood glucose control and outcomes for the woman and baby

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For pregnant women with type 2 diabetes who are already receiving glucose-lowering medication, recommend that medications with safety concerns during pregnancy be replaced with insulin and/or metformin.

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For pregnant women with type 2 diabetes who required insulin to achieve optimal blood glucose levels before pregnancy, recommend continuation of the same type of insulin unless a change is considered necessary to optimize blood glucose control and outcomes for the woman and baby

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For women with gestational diabetes mellitus (GDM) who are unable to achieve optimal blood glucose levels with diet and physical activity alone, recommend initiation of metformin or insulin to optimize blood glucose control and outcomes for the woman and baby

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For women with gestational diabetes mellitus (GDM) who are receiving monotherapy with metformin or insulin and are unable to achieve optimal blood glucose levels, consider initiation of a combination of metformin and insulin to optimize blood glucose control and outcomes for the woman and baby.

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For pregnant women with type 1, type 2 or gestational diabetes, perform a routine ultrasound scan before 24 weeks.

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For pregnant women with type 1 or type 2 diabetes, consider performing the routine ultrasound scan as early as possible in pregnancy with a follow-up ultrasound to assess fetal anatomy and growth in the second trimester.

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For pregnant women with type 1, type 2 or gestational diabetes, consider additional ultrasound growth scans after 24 weeks, as indicated.

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For pregnant women with type 1, type 2 or gestational diabetes requiring blood glucose-lowering medication, consider additional monitoring of fetal wellbeing, as indicated.

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For pregnant women with type 1 or type 2 diabetes, screen for retinopathy when antenatal care is initiated and provide follow-up based on the risk of retinopathy progressing

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For women with gestational diabetes mellitus (GDM), do not routinely screen for retinopathy

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For pregnant women with type 1 or type 2 diabetes, assess renal function when antenatal care is initiated and arrange specialist follow-up for women if impaired renal function is identified

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For women with gestational diabetes mellitus (GDM) do not routinely assess renal function

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For pregnant women with type 1 or type 2 diabetes with impaired renal function, emphasize the importance of maintaining blood pressure levels below 130/80 mmHg during pregnancy and offer antihypertensives known to be safe in pregnancy as indicated. Advise women to modify major risk factors for cardiovascular disease (e.g. smoking, unhealthy diet, sedentary behaviour) and to seek specialist postnatal follow-up.

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