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Obesity

Comprehensive Management of Type 2 Diabetes During Pregnancy

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JAMA

Published Online: March 10, 2023

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Article Information and Disclosures

Amy M. Valent, DO, MCR¹;

Aaron B. Caughey, MD, MPH, PhD¹

Author Affiliations

¹Division of Maternal-Fetal Medicine, Department Obstetrics & Gynecology, Oregon Health & Science University, Portland

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Type 2 diabetes (T2D) is associated with maternal and offspring complications (eFigure in the Supplement). Although the prevalence of type 1 diabetes during pregnancy has remained stable, the prevalence of T2D has increased from 1.8 to 7.3 per 1000 deliveries in the past 10 years.¹ The pathogenesis of T2D leads to progressive insulin resistance, defective pancreatic beta cell insulin secretion, and inappropriate glucagon secretion by the alpha cells. The multiorgan metabolic dysregulation of T2D complicates the dynamic physiologic and metabolic changes necessary during pregnancy to grow and develop a healthy fetus. Therefore, addressing the factors that affect the metabolic complexity of T2D optimizes glycemia and promotes a healthier intrauterine environment.

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Article Information

Corresponding Author: Amy M. Valent, DO, MCR, Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Rd, L466, Portland, OR 97239 (valent@ohsu.edu).

Published Online: March 10, 2023. doi:10.1001/jama.2023.0929

Conflict of Interest Disclosures: Dr Valent reported providing unpaid consulting for Dexcom outside the submitted work. No other disclosures were reported.

References

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ElSayed NA , Aleppo G , Aroda VR , et al; on behalf of the American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of care in diabetes: 2023. Diabetes Care. 2023;46(suppl 1):s19-s40. doi:10.2337/dc23-S002 PubMed Google Scholar Crossref

Sweeting A , Mijatovic J , Brinkworth GD , et al. The carbohydrate threshold in pregnancy and gestational diabetes: how low can we go? Nutrients. 2021;13(8):2599. doi:10.3390/nu13082599 PubMed Google Scholar Crossref

Cantor AG , Jungbauer RM , McDonagh M , et al. Counseling and behavioral interventions for healthy weight and weight gain in pregnancy: evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2021;325(20):2094-2109. doi:10.1001/jama.2021.4230 PubMed Google Scholar Crossref

Feig DS , Donovan LE , Zinman B , et al; MiTy Collaborative Group. Metformin in women with type 2 diabetes in pregnancy (MiTy): a multicentre, international, randomised, placebo-controlled trial. Lancet Diabetes Endocrinol. 2020;8(10):834-844. doi:10.1016/S2213-8587(20)30310-7 PubMed Google Scholar Crossref

Feig DS , Donovan LE , Corcoy R , et al; CONCEPTT Collaborative Group. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet. 2017;390(10110):2347-2359. doi:10.1016/S0140-6736(17)32400-5 PubMed Google Scholar Crossref

Caughey AB , Valent AM . When to deliver women with diabetes in pregnancy? Am J Perinatol. 2016;33(13):1250-1254. doi:10.1055/s-0036-1585589 PubMed Google Scholar Crossref

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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
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