Management of type 1 diabetes in pregnancy: update on lifestyle, pharmacological treatment, and novel technologies for achieving glycaemic targets

Katrien Benhalima*, Kaat Beunen, Sarah E Siegelaar, Rebecca Painter, Helen R Murphy, Denice S Feig, Lois E Donovan, Sarit Polsky, Elizabeth Buschur, Carol J Levy, Yogish C Kudva, Tadej Battelino, Lene Ringholm, Elisabeth R Mathiesen, Chantal Mathieu

*Corresponding author af dette arbejde

    Abstract

    Glucose concentrations within target, appropriate gestational weight gain, adequate lifestyle, and, if necessary, antihypertensive treatment and low-dose aspirin reduces the risk of pre-eclampsia, preterm delivery, and other adverse pregnancy and neonatal outcomes in pregnancies complicated by type 1 diabetes. Despite the increasing use of diabetes technology (ie, continuous glucose monitoring and insulin pumps), the target of more than 70% time in range in pregnancy (TIRp 3·5-7·8 mmol/L) is often reached only in the final weeks of pregnancy, which is too late for beneficial effects on pregnancy outcomes. Hybrid closed-loop (HCL) insulin delivery systems are emerging as promising treatment options in pregnancy. In this Review, we discuss the latest evidence on pre-pregnancy care, management of diabetes-related complications, lifestyle recommendations, gestational weight gain, antihypertensive treatment, aspirin prophylaxis, and the use of novel technologies for achieving and maintaining glycaemic targets during pregnancy in women with type 1 diabetes. In addition, the importance of effective clinical and psychosocial support for pregnant women with type 1 diabetes is also highlighted. We also discuss the contemporary studies examining HCL systems in type 1 diabetes during pregnancies.

    OriginalsprogEngelsk
    TidsskriftThe Lancet Diabetes and Endocrinology
    Vol/bind11
    Udgave nummer7
    Sider (fra-til)490-508
    Antal sider19
    ISSN2213-8587
    DOI
    StatusUdgivet - jul. 2023

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