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Comprehensive Management of Type 2 Diabetes During Pregnancy

To identify the key insights or developments described in this article
1 Credit CME

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
1.
Gorsch  LP , Wen  T , Lonier  JY ,  et al.  Trends in delivery hospitalizations with pregestational and gestational diabetes mellitus and associated outcomes: 2000-2019.   Am J Obstet Gynecol. Published online December 9, 2022. doi:10.1016/j.ajog.2022.12.006PubMedGoogle ScholarCrossref
2.
Wahabi  HA , Fayed  A , Esmaeil  S ,  et al.  Systematic review and meta-analysis of the effectiveness of pre-pregnancy care for women with diabetes for improving maternal and perinatal outcomes.   PLoS One. 2020;15(8):e0237571. doi:10.1371/journal.pone.0237571PubMedGoogle ScholarCrossref
3.
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-S002PubMedGoogle ScholarCrossref
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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/nu13082599PubMedGoogle ScholarCrossref
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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.2021.4230PubMedGoogle ScholarCrossref
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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)30310-7PubMedGoogle ScholarCrossref
7.
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)32400-5PubMedGoogle ScholarCrossref
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Caughey  AB , Valent  AM .  When to deliver women with diabetes in pregnancy?   Am J Perinatol. 2016;33(13):1250-1254. doi:10.1055/s-0036-1585589PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

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
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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