1st ever: WHO releases recommendations on care for women with diabetes during pregnancy

On the occasion of World Diabetes Day on 14 November 2025, the WHO released its first global guideline specifically addressing the care of women with diabetes during pregnancy—whether pre-existing (type 1 or type 2) or newly diagnosed in pregnancy (gestational diabetes).

According to WHO, diabetes in pregnancy significantly increases the risk of pre-eclampsia, obstructed labour, neonatal hypoglycaemia, stillbirth and long-term metabolic disorders in both mother and child. The burden is highest in low- and middle-income countries, where access to specialised maternal-diabetes services remains limited.

The new guideline consolidates evidence-based recommendations on diagnosis, lifestyle management, glucose monitoring and pharmacological therapy. WHO emphasises individualised care, including nutrition counselling, physical activity guidance and glucose-target setting based on local resources. The document also highlights the importance of integrating diabetes management into routine antenatal care through a multidisciplinary model involving obstetricians, endocrinologists, nurses and dietitians.

Following the major recommendations:

Core Practices in Caring for Women With Diabetes During Pregnancy

Advice on diet, physical activity and weight management

1. For pregnant women with type 1, type 2 or gestational diabetes, provide individualized advice on diet, physical activity and weight management based on existing WHO guidance, including:

• dietary advice for the general adult population;

• physical activity advice for the general pregnant population;

• weight management advice based on the above dietary and physical activity advice, with a focus on appropriate gestational weight gain.

Antenatal education

2. For pregnant women with type 1, type 2 or gestational diabetes, provide education on:

• the effects of diabetes in pregnancy on maternal, fetal, newborn and child health outcomes;

• diet and physical activity;

• appropriate gestational weight gain;

• managing glycaemia;

• the need for additional monitoring of fetal growth and wellbeing.

Specialized care

3. For pregnant women with type 1 or type 2 diabetes, deliver multidisciplinary and specialized care provided by health-care providers trained in maternal and diabetes care.

4. For women with GDM, consider multidisciplinary and specialized care provided by health-care providers trained in maternal and diabetes care, depending on access and availability.

Glucose monitoring

5. For pregnant women with type 1, type 2 or gestational diabetes, recommend self-monitoring of blood glucose (SMBG) in addition to routine care, where feasible.

6. For pregnant women with type 1 diabetes, recommend the use of a continuous glucose monitoring (CGM) system, where feasible.

7. For pregnant women with type 2 or gestational diabetes, do not routinely recommend use of a CGM system.

8. For pregnant women with type 1 or type 2 diabetes, measure HbA1c in the first trimester or as soon as antenatal care is initiated.

9. For women with GDM, do not routinely measure HbA1c.

Glycaemic targets

10. For pregnant women with type 1, type 2 or gestational diabetes, individualize glycaemic targets to optimize glycaemic control and improve maternal and neonatal outcomes.

Pharmacological treatment

Type 1 diabetes

11. For pregnant women with type 1 diabetes, recommend continuation of the same type of insulin used before pregnancy unless a change is considered necessary to optimize blood glucose control and outcomes for the woman and baby.

12. For pregnant women with type 1 diabetes, recommend continuation of the method of insulin delivery used before pregnancy unless a change is considered necessary to optimize blood glucose control and outcomes for the woman and baby.

Type 2 diabetes

13. For pregnant women with type 2 diabetes who are unable to maintain optimal blood glucose levels with diet and physical activity alone, recommend initiation of metformin or insulin to optimize blood glucose control and outcomes for the woman and baby.

14. For pregnant women with type 2 diabetes who are receiving monotherapy with insulin or metformin and who are unable to achieve optimal blood glucose levels, consider initiation of a combination of metformin and insulin to optimize blood glucose control and outcomes for the woman and baby.

15. For pregnant women with type 2 diabetes who are already receiving glucose-lowering medication, recommend that medications with safety concerns during pregnancy be replaced with insulin and/or metformin.

16. For pregnant women with type 2 diabetes who required insulin to achieve optimal blood glucose levels before pregnancy, recommend continuation of the same type of insulin unless a change is considered necessary to optimize blood glucose control and outcomes for the woman and baby.

Gestational diabetes (GDM)

17. For women with GDM who are unable to achieve optimal blood glucose levels with diet and physical activity alone, recommend initiation of metformin or insulin to optimize blood glucose control and outcomes for the woman and baby.

18. For women with GDM who are receiving monotherapy with metformin or insulin and are unable to achieve optimal blood glucose levels, consider initiation of a combination of metformin and insulin to optimize blood glucose control and outcomes for the woman and baby.

Additional monitoring and assessments

Fetal monitoring

19. For pregnant women with type 1, type 2 or gestational diabetes, perform a routine ultrasound scan before 24 weeks.

20. For pregnant women with type 1 or type 2 diabetes, consider performing the routine ultrasound scan as early as possible in pregnancy, with a follow-up ultrasound to assess fetal anatomy and growth in the second trimester.

21. For pregnant women with type 1, type 2 or gestational diabetes, consider additional ultrasound growth scans after 24 weeks, as indicated.

22. For pregnant women with type 1, type 2 or gestational diabetes requiring blood glucose-lowering medication, consider additional monitoring of fetal wellbeing, as indicated.

Retinopathy screening

23. For pregnant women with type 1 or type 2 diabetes, screen for retinopathy when antenatal care is initiated and provide follow-up based on the risk of retinopathy progressing.

24. For women with GDM, do not routinely screen for retinopathy.

Renal assessment

25. For pregnant women with type 1 or type 2 diabetes, assess renal function when antenatal care is initiated and arrange specialist follow-up for women if impaired renal function is identified.

26. For women with GDM, do not routinely assess renal function.

27. For pregnant women with type 1 or type 2 diabetes with impaired renal function, emphasize the importance of maintaining blood pressure levels below 130/80 mmHg during pregnancy and offer antihypertensives known to be safe in pregnancy as indicated. Advise women to modify major risk factors for cardiovascular disease (e.g. smoking, unhealthy diet, sedentary behaviour) and to seek specialist postnatal follow-up.