Diabetes in pregnancy: management from preconception to the postnatal period

The evidence

This section provides a summary of the areas that will be updated and the reasons for the decision to update.

1.3 Antenatal care for women with diabetes

There is new evidence on continuous glucose monitoring. In particular, the CONCEPTT trial has published which experts deem to be a landmark trial that provides the best available evidence for the foreseeable future. The CONCEPTT trial found improvements in a range of neonatal outcomes with continuous glucose monitoring plus standard care, compared with standard care alone, and advocates routine usage in pregnant women with type 1 diabetes. This could potentially alter recommendation 1.3.17, which currently advises do not offer continuous glucose monitoring routinely to pregnant women with diabetes.

The CONCEPTT trial also included the use of continuous glucose monitoring during the preconception period. There were less clear benefits during the planning pregnancy stage, possibly due to the small sample size, but the authors noted that women may be uncomfortable changing monitoring modality during early pregnancy, thus initiating continuous glucose monitoring pre-pregnancy may be of benefit. This evidence could potentially impact on section 1.1 on continuous glucose monitoring during preconception planning and care.

As such, a partial update is proposed focused on continuous glucose monitoring in women with type 1 diabetes who are planning to become pregnant or already pregnant.

The evidence identified in relation to other areas of the guideline supports current recommendations or is not expected to impact on current recommendations due to insufficient evidence or heterogeneity across studies resulting in unclear benefits.

For further details and a summary of all evidence identified in surveillance, see appendix A.