Sec­tion 15. Man­age­ment of Di­a­betes in Preg­nan­cy

(https:/​/​doi.org/​10.2337/​dc23-​S015)

Rec­om­men­da­tion 15.13 was added to en­dorse nu­tri­tion coun­sel­ing to im­prove the qual­i­ty of car­bo­hy­drates and pro­mote a bal­ance of macronu­tri­ents in­clud­ing nu­tri­ent-​dense fruits, veg­eta­bles, legumes, whole grains, and healthy fats with n-​3 fat­ty acids that in­clude nuts and seeds and fish in the eat­ing pat­tern.

Ev­i­dence for pre­con­cep­tion coun­sel­ing was strength­ened.

A new study demon­strates that the cost of CGM in preg­nan­cies com­pli­cat­ed by type 1 di­a­betes is off­set by im­proved ma­ter­nal and neona­tal out­comes and pro­vides fur­ther sup­port for the use CGM.

Rec­om­men­da­tion 15.20 is now a com­pos­ite rec­om­men­da­tion based on two dif­fer­ent mul­ti­cen­tered RCTs with dif­fer­ent method­olo­gies and dif­fer­ent out­comes. Both RCTs sup­port stricter blood pres­sure tar­gets in preg­nan­cy to im­prove out­comes. This modification is based on new data from the Chron­ic Hy­per­ten­sion and Preg­nan­cy (CHAP) tri­al, which in­clud­ed in­di­vid­u­als with pre­ex­ist­ing di­a­betes.

The new Rec­om­men­da­tion 15.27 sup­ports breast­feed­ing to re­duce the risk of ma­ter­nal type 2 di­a­betes. The benefit of breast­feed­ing should be con­sid­ered when choos­ing whether to breast­feed or for­mu­la feed.

New lan­guage was added to the text re­gard­ing the role of weight/​BMI af­ter ges­ta­tion­al di­a­betes mel­li­tus (GDM). Sys­tem­at­ic re­views and meta-​anal­y­ses demon­strate each of the fol­low­ing: weight loss re­duces the risk of de­vel­op­ing GDM in the sub­se­quent preg­nan­cy, the risk of type 2 di­a­betes in­creas­es by 18% per unit of BMI above the prepreg­nan­cy BMI at fol­low-​up, and post-​de­liv­ery lifestyle in­ter­ven­tions are ef­fec­tive in re­duc­ing risk of type 2 di­a­betes. These stud­ies high­light the im­por­tance of ef­fec­tive weight man­age­ment af­ter GDM.