Pre-existing diabetes in pregnancy
Preconception targets and medicine changes, glucose and CGM targets, how insulin needs change through pregnancy, retinopathy, nephropathy, DKA, birth and the postpartum fall in insulin requirement.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Type 1 and type 2 diabetes both raise the risk of congenital anomalies, miscarriage, pre-eclampsia, macrosomia, stillbirth and neonatal hypoglycaemia. Risk tracks glycaemia around conception.
- Outcomes in type 2 diabetes are as bad as, or worse than, type 1: older, heavier mothers, more unplanned pregnancies and less preconception care.
- Plan pregnancy: HbA1c 48 mmol/mol (6.5%) or less if safe, folic acid 5 mg, retinal review, and stop ACE inhibitors, ARBs, statins and non-insulin glucose-lowering drugs (metformin excepted).
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Sources
- ADIPS consensus guideline for the management of pre-existing diabetes in pregnancy (summarised in: Callaway LK, Britten F. Managing pre-existing diabetes prior to and during pregnancy. Aust Prescr 2024;47:2-6)AU/NZAustralasian Diabetes in Pregnancy Society / Australian Prescriber, 2020 guideline; 2024 summary (no newer ADIPS pre-existing diabetes guideline found, November 2026)
- Australasian Diabetes in Pregnancy Society (ADIPS) 2025 consensus recommendations for the screening, diagnosis and classification of gestational diabetesAU/NZSweeting A, Hare MJL, Jersey SJ, et al. Med J Aust 2025;223(3), 2025
- Standards of Care in Diabetes 2026, section 15: Management of diabetes in pregnancyAmerican Diabetes Association (Diabetes Care 2026;49 Suppl 1:S321-S338), 2026
- Therapeutic Guidelines: Diabetes (pre-existing diabetes in pregnancy)AU/NZTherapeutic Guidelines Limited
- Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT)Feig DS et al. Lancet 2017;390:2347-59, 2017
- Automated insulin delivery in women with pregnancy complicated by type 1 diabetes (AiDAPT)Lee TTM et al. N Engl J Med 2023;389:1566-78, 2023
- Metformin in women with type 2 diabetes in pregnancy (MiTy): a multicentre, international, randomised, placebo-controlled trialFeig DS et al. Lancet Diabetes Endocrinol 2020;8:834-44, 2020
- Diabetes in pregnancy: management from preconception to the postnatal period (NG3)National Institute for Health and Care Excellence
- FDA requests removal of strongest warning against using cholesterol-lowering statins during pregnancy (Drug Safety Communication)US Food and Drug Administration, 20 July 2021
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback