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Exp Clin Endocrinol Diabetes 2023; 131(01/02): 4-12
DOI: 10.1055/a-1946-3648
German Diabetes Association: Clinical Practice Guidelines

Diabetes and Pregnancy

Michael Hummel
1   Internal Medicine Group Practice and Diabetological Practice, Rosenheim, Germany
2   Research Group Diabetes e.V. at Helmholtz Center Munich, Munich, Germany
,
Martin Füchtenbusch
2   Research Group Diabetes e.V. at Helmholtz Center Munich, Munich, Germany
3   Diabetes Center am Marienplatz Munich, Munich, Germany
,
Wilgard Battefeld
4   Diabetology and Endocrinology, Medical Care Center Kempten-Allgäu, Kempten, Germany
,
Christoph Bührer
5   Department of Neonatology, Charité – Medical University of Berlin, Berlin, Germany
,
Tanja Groten
6   Department of Obstetrics and Maternal Health, University Hospital Jena, Jena, Germany
,
Thomas Haak
7   Diabetes Center Mergentheim, Bad Mergentheim, Germany
,
Franz Kainer
8   Department of Obstetrics and Prenatal Medicine, Hallerwiese Hospital, Nuremberg, Germany
,
Alexandra Kautzky-Willer
9   Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
,
Andreas Lechner
10   Department of Internal Medicine IV, Diabetes Center, Ludwigs-Maximilians-University Munich, Munich, Germany
,
Thomas Meissner
11   Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
,
Christine Nagel-Reuper
12   Diabetes Practice Northeim, Northeim, Germany
,
Ute Schäfer-Graf
13   Berlin Diabetes Center for Pregnant Women, St. Joseph Hospital Berlin Tempelhof, Berlin, Germany
,
Thorsten Siegmund
14   Diabetes, Hormone, and Metabolism Center, Private Practice at Isar Clinic, Munich, Germany
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Notice of update

The DDG practice recommendations are updated regularly during the second half of the calendar year. Please ensure that you read and cite the respective current version.



Publication History

Article published online:
10 January 2023

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  • References

  • 1 American College of Obstetricians and Gynecologists (ACOG) ACOG Committee Opinion number 315, September 2005. Obesity in pregnancy. Obstet Gynecol 2005; 106: 671-675
    PubMedGoogle Scholar
  • 2 Barbour LA. Changing perspectives in pre-existing diabetes and obesity in pregnancy: Maternal and infant short- and long-term outcomes. Curr Opin Endocrinol Diabetes Obes 2014; 21: 257-263
    CrossrefPubMedGoogle Scholar
  • 3 Metwally M, Ong KJ, Ledger WL. et al. Does high body mass index increase the risk of miscarriage after spontaneous and assisted conception? A meta-analysis of the evidence. Fertil Steril 2008; 90: 714-726
    CrossrefPubMedGoogle Scholar
  • 4 van der Steeg JW, Steures P, Eijkemans MJC. et al. Obesity affects spontaneous pregnancy chances in subfertile, ovulatory women. Hum Reprod 2008; 23: 324-328
    CrossrefPubMedGoogle Scholar
  • 5 Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG). S2k-Leitlinie Prävention und Therapie der Frühgeburtlichkeit Version 1.0. Stand Februar 2019. 2018. Retrieved from: https://www.awmf.org/leitlinien/detail/ll/015-025.html; accessed: 13.06.2020
    PubMed
  • 6 Araujo J, Brandão LAC, Guimarães RL. et al. Prevalence of autoimmune thyroid disease and thyroid dysfunction in young Brazilian patients with type 1 diabetes. Pediatr Diabetes 2008; 9: 272-276
    CrossrefPubMedGoogle Scholar
  • 7 Dittmar M, Kahaly GJ. Polyglandular autoimmune syndromes: Immunogenetics and long-term follow-up. J Clin Endocrinol Metab 2003; 88: 2983-2992
    CrossrefPubMedGoogle Scholar
  • 8 Hunger-Battefeld W, Fath K, Mandecka A. et al. Prävalenz eines polyglandulären Autoimmunsyndroms bei Patienten mit Diabetes mellitus Typ 1. Med Klin (Munich) 2009; 104: 183-191
    CrossrefPubMedGoogle Scholar
  • 9 Rabe M, Groten T, Dawczynski K. et al. Tranzplazentarer Autoantikörpertransfer bei Schwangeren mit Typ 1 Diabetes mellitus bzw. polyglandulärem Autoimmunsyndrom. Diabetologie 2015; 10: 322-328
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Bell R, Glinianaia SV, Tennant PWG. et al. Peri-conception hyperglycaemia and nephropathy are associated with risk of congenital anomaly in women with pre-existing diabetes: A population-based cohort study. Diabetologia 2012; 55: 936-947
    CrossrefPubMedGoogle Scholar
  • 11 Cyganek K, Skupien J, Katra B. et al. Risk of macrosomia remains glucosedependent in a cohort of women with pregestational type 1 diabetes and good glycemic control. Endocrine 2017; 55: 447-455
    CrossrefPubMedGoogle Scholar
  • 12 Holmes VA, Young IS, Patterson CC. et al. Optimal glycemic control, preeclampsia, and gestational hypertension in women with type 1 diabetes in the diabetes and preeclampsia intervention trial. Diabetes Care 2011; 34: 1683-1688
    CrossrefPubMedGoogle Scholar
  • 13 Ludvigsson JF, Neovius M, Söderling J. et al. Maternal Glycemic Control in Type 1 Diabetes and the Risk for Preterm Birth: A Population-Based Cohort Study. Ann Intern Med 2019; 170: 691-701
    CrossrefPubMedGoogle Scholar
  • 14 Tennant PWG, Glinianaia SV, Bilous RW. et al. Pre-existing diabetes, maternal glycated haemoglobin, and the risks of fetal and infant death: A population-based study. Diabetologia 2014; 57: 285-294
    CrossrefPubMedGoogle Scholar
  • 15 Feig DS, Corcoy R, Donovan LE. et al. Pumps or Multiple Daily Injections in Pregnancy Involving Type 1 Diabetes: A Prespecified Analysis of the CONCEPTT Randomized Trial. Diabetes Care 2018; 41: 2471-2479
    CrossrefPubMedGoogle Scholar
  • 16 Glinianaia SV, Tennant PWG, Bilous RW. et al. HbA(1c) and birthweight in women with pre-conception type 1 and type 2 diabetes: A populationbased cohort study. Diabetologia 2012; 55: 3193-3203
    CrossrefPubMedGoogle Scholar
  • 17 Mackin ST, Nelson SM, Wild SH. et al. Factors associated with stillbirth in women with diabetes. Diabetologia 2019; 62: 1938-1947
    CrossrefPubMedGoogle Scholar
  • 18 Björklund AO, Adamson UK, Almström NH. et al. Effects of hypoglycaemia on fetal heart activity and umbilical artery Doppler velocity waveforms in pregnant women with insulin-dependent diabetes mellitus. Br J Obstet Gynaecol 1996; 103: 413-420
    CrossrefPubMedGoogle Scholar
  • 19 Naik D, Hesarghatta Shyamasunder A, Doddabelavangala Mruthyunjaya M. et al. Masked hypoglycemia in pregnancy. J Diabetes 2017; 9: 778-786
    CrossrefPubMedGoogle Scholar
  • 20 Reece EA, Hagay Z, Roberts AB. et al. Fetal Doppler and behavioral responses during hypoglycemia induced with the insulin clamp technique in pregnant diabetic women. Am J Obstet Gynecol 1995; 172: 151-155
    CrossrefPubMedGoogle Scholar
  • 21 ter Braak EWMT, Evers IM, Willem Erkelens D. et al. Maternal hypoglycemia during pregnancy in type 1 diabetes: Maternal and fetal consequences. Diabetes Metab Res Rev 2002; 18: 96-105
    CrossrefPubMedGoogle Scholar
  • 22 Lorenzen T, Pociot F, Johannesen J. et al. A population-based survey of frequencies of self-reported spontaneous and induced abortions in Danish women with Type 1 diabetes mellitus. Danish IDDM Epidemiology and Genetics Group. Diabet Med 1999; 16: 472-476
    CrossrefPubMedGoogle Scholar
  • 23 Mills JL. Malformations in infants of diabetic mothers. Teratology 1982; 25: 385-394
    CrossrefPubMedGoogle Scholar
  • 24 Rosenn B, Miodovnik M, Combs CA. et al. Glycemic thresholds for spontaneous abortion and congenital malformations in insulin-dependent diabetes mellitus. Obstet Gynecol 1994; 84: 515-520
    PubMedGoogle Scholar
  • 25 Sutherland HW, Pritchard CW. Increased incidence of spontaneous abortion in pregnancies complicated by maternal diabetes mellitus. Am J Obstet Gynecol 1987; 156: 135-138
    CrossrefPubMedGoogle Scholar
  • 26 Becerra JE, Khoury MJ, Cordero JF. et al. Diabetes mellitus during pregnancy and the risks for specific birth defects: A population-based casecontrol study. Pediatrics 1990; 85: 1-9
    CrossrefPubMedGoogle Scholar
  • 27 Chou H-H, Chiou M-J, Liang F-W. et al. Association of maternal chronic disease with risk of congenital heart disease in offspring. CMAJ 2016; 188: E438-E446
    CrossrefPubMedGoogle Scholar
  • 28 Zhao E, Zhang Y, Zeng X. et al. Association between maternal diabetes mellitus and the risk of congenital malformations: A meta-analysis of cohort studies. Drug Discov Ther 2015; 9: 274-281
    CrossrefPubMedGoogle Scholar
  • 29 Vinceti M, Malagoli C, Rothman KJ. et al. Risk of birth defects associated with maternal pregestational diabetes. Eur J Epidemiol 2014; 29: 411-418
    CrossrefPubMedGoogle Scholar
  • 30 Callec R, Perdriolle-Galet E, Sery G-A. et al. Type 2 diabetes in pregnancy: Rates of fetal malformations and level of preconception care. J Obstet Gynaecol 2014; 34: 648-649
    CrossrefPubMedGoogle Scholar
  • 31 Evers IM, de Valk HW, Visser GHA. Risk of complications of pregnancy in women with type 1 diabetes: Nationwide prospective study in the Netherlands. BMJ 2004; 328: 7445 915
    CrossrefPubMedGoogle Scholar
  • 32 Hoang TT, Marengo LK, Mitchell LE. et al. Original Findings and Updated Meta-Analysis for the Association Between Maternal Diabetes and Risk for Congenital Heart Disease Phenotypes. Am J Epidemiol 2017; 186: 118-128
    CrossrefPubMedGoogle Scholar
  • 33 Liu S, Joseph KS, Lisonkova S. et al. Association between maternal chronic conditions and congenital heart defects: A population-based cohort study. Circulation 2013; 128: 583-589
    CrossrefPubMedGoogle Scholar
  • 34 Schaefer-Graf UM, Buchanan TA, Xiang A. et al. Patterns of congenital anomalies and relationship to initial maternal fasting glucose levels in pregnancies complicated by type 2 and gestational diabetes. Am J Obstet Gynecol 2000; 182: 313-320
    CrossrefPubMedGoogle Scholar
  • 35 Simeone RM, Devine OJ, Marcinkevage JA. et al. Diabetes and congenital heart defects: A systematic review, meta-analysis, and modeling project. Am J Prev Med 2015; 48: 195-204
    CrossrefPubMedGoogle Scholar
  • 36 Slot A, Eriksen NB, Ringholm L. et al. Congenital heart defects in offspring of women with Type 2 diabetes – a systematic review. Dan Med J 2019; 66: A5543
    PubMedGoogle Scholar
  • 37 Martínez-Frías ML, Rodríguez-Pinilla E, Bermejo E. et al. Epidemiological evidence that maternal diabetes does not appear to increase the risk for Down syndrome. Am J Med Genet 2002; 112: 335-337
    CrossrefPubMedGoogle Scholar
  • 38 Wu Y, Liu B, Sun Y. et al. Association of Maternal Prepregnancy Diabetes and Gestational Diabetes Mellitus With Congenital Anomalies of the Newborn. Diabetes Care 2020; 43: 2983-2990
    CrossrefPubMedGoogle Scholar
  • 39 Correa A, Botto L, Liu Y. et al. Do multivitamin supplements attenuate the risk for diabetes-associated birth defects?. Pediatrics 2003; 111: 1146-1151
    CrossrefPubMedGoogle Scholar
  • 40 Li K, Yang C, Fan J. et al. Prepregnancy body mass index, gestational weight gain, and maternal prepartum inflammation in normal pregnancies: findings from a Chinese cohort. BMC Pregnancy Childbirth 2022; 22: 531
    CrossrefPubMedGoogle Scholar
  • 41 Jovanovic L, Knopp RH, Kim H. et al. Elevated pregnancy losses at high and low extremes of maternal glucose in early normal and diabetic pregnancy: Evidence for a protective adaptation in diabetes. Diabetes Care 2005; 28: 1113-1117
    CrossrefPubMedGoogle Scholar
  • 42 Xiang L-J, Wang Y, Lu G-Y. et al. Association of the presence of microangiopathy with adverse pregnancy outcome in type 1 diabetes: A metaanalysis. Taiwan J Obstet Gynecol 2018; 57: 659-664
    CrossrefPubMedGoogle Scholar
  • 43 Acolet D. Description of the babies and Standards of care for the babies. In: Macintosh M, Hrsg. Pregnancy in Women with Type 1 and Type 2 Diabetes in 2002-2003, England, Wales and Northern Ireland. London: CEMACH; 2005: 37-49 Retrieved from: https://elearning.rcog.org.uk//sites/default/files/Diabetes%20and%20other%20endocrinopathies/CEMACH_Pregnancy_type_1_2_diabetes.pdf; accessed: 28.06.2022
    Google Scholar
  • 44 Boulot P, Chabbert-Buffet N, d’Ercole C. et al. French multicentric survey of outcome of pregnancy in women with pregestational diabetes. Diabetes Care 2003; 26: 2990-2993
    CrossrefPubMedGoogle Scholar
  • 45 Chaudhry T, Ghani AM, Mehrali TH. et al. A comparison of foetal and labour outcomes in Caucasian and Afro-Caribbean women with diabetes in pregnancy. Int J Clin Pract 2004; 58: 932-936
    CrossrefPubMedGoogle Scholar
  • 46 Clausen TD, Mathiesen E, Ekbom P. et al. Poor pregnancy outcome in women with type 2 diabetes. Diabetes Care 2005; 28: 323-328
    CrossrefPubMedGoogle Scholar
  • 47 Cundy T, Gamble G, Townend K. et al. Perinatal mortality in Type 2 diabetes mellitus. Diabet Med 2000; 17: 33-39
    CrossrefPubMedGoogle Scholar
  • 48 Dunne F, Brydon P, Smith K. et al. Pregnancy in women with Type 2 diabetes: 12 years outcome data 1990-2002. Diabet Med 2003; 20: 734-738
    CrossrefPubMedGoogle Scholar
  • 49 Poston L, Caleyachetty R, Cnattingius S. et al. Preconceptional and maternal obesity: Epidemiology and health consequences. Lancet Diabetes Endocrinol 2016; 4: 1025-1236
    CrossrefPubMedGoogle Scholar
  • 50 American Diabetes Association (ADA) 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care 2020; 43: S14-S31
    CrossrefPubMedGoogle Scholar
  • 51 Harreiter J, Simmons D, Desoye G. et al. IADPSG and WHO 2013 Gestational Diabetes Mellitus Criteria Identify Obese Women With Marked Insulin Resistance in Early Pregnancy. Diabetes Care 2016; 39: e90-e92
    CrossrefPubMedGoogle Scholar
  • 52 Ray JG, O’Brien TE, Chan WS. Preconception care and the risk of congenital anomalies in the offspring of women with diabetes mellitus: A meta-analysis. QJM 2001; 94: 435-444
    CrossrefPubMedGoogle Scholar
  • 53 Garcia-Patterson A, Corcoy R, Rigla M. et al. Does preconceptional counselling in diabetic women influence perinatal outcome?. Ann Ist Super Sanita 1997; 33: 333-336
    PubMedGoogle Scholar
  • 54 Willhoite MB, Bennert HWJR, Palomaki GE. et al. The impact of preconception counseling on pregnancy outcomes. The experience of the Maine Diabetes in Pregnancy Program. Diabetes Care 1993; 16: 450-455
    CrossrefPubMedGoogle Scholar
  • 55 American Diabetes Association (ADA) 13. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes-2018. Diabetes Care 2018; 41: S137-S143
    CrossrefPubMedGoogle Scholar
  • 56 Lindsay RS, Loeken MR. Metformin use in pregnancy: Promises and uncertainties. Diabetologia 2017; 60: 1612-1619
    CrossrefPubMedGoogle Scholar
  • 57 Balsells M, Garcia-Patterson A, Sola I. et al. Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: A systematic review and meta-analysis. BMJ 2015; 350: h102
    Google Scholar
  • 58 Camelo Castillo W, Boggess K, Stürmer T. et al. Association of Adverse Pregnancy Outcomes With Glyburide vs Insulin in Women With Gestational Diabetes. JAMA Pediatr 2015; 169: 452-458
    Google Scholar
  • 59 National Institute for Health and Care Excellence (NICE) Diabetes in Pregnancy: Management of Diabetes and Its Complications from Preconception to the Postnatal Period. NICE guideline (NG 3). 2015
    PubMedGoogle Scholar
  • 60 Ainuddin JA, Karim N, Zaheer S. et al. Metformin treatment in type 2 diabetes in pregnancy: An active controlled, parallel-group, randomized, open label study in patients with type 2 diabetes in pregnancy. J Diabetes Res 2015; 2015: 325851
    CrossrefPubMedGoogle Scholar
  • 61 Tieu J, Coat S, Hague W. et al. Oral anti-diabetic agents for women with established diabetes/impaired glucose tolerance or previous gestational diabetes planning pregnancy, or pregnant women with pre-existing diabetes. Cochrane Database Syst Rev 2017; 10: CD007724
    PubMedGoogle Scholar
  • 62 Rowan JA, Rush EC, Obolonkin V. et al. Metformin in gestational diabetes: The offspring follow-up (MiG TOFU): body composition at 2 years of age. Diabetes Care 2011; 34: 2279-2284
    CrossrefPubMedGoogle Scholar
  • 63 Rowan JA, Rush EC, Plank LD. et al. Metformin in gestational diabetes: The offspring follow-up (MiG TOFU): body composition and metabolic outcomes at 7–9 years of age. BMJ Open Diabetes Res Care 2018; 6: e000456
    CrossrefPubMedGoogle Scholar
  • 64 Hanem LGE, Stridsklev S, Juliusson PB. et al. Metformin Use in PCOS Pregnancies Increases the Risk of Offspring Overweight at 4 Years of Age: Follow-Up of Two RCTs. J Clin Endocrinol Metab 2018; 103: 1612-1621
    CrossrefPubMedGoogle Scholar
  • 65 Tarry-Adkins JL, Aiken CE, Ozanne SE. Neonatal, infant, and childhood growth following metformin versus insulin treatment for gestational diabetes: A systematic review and meta-analysis. PLoS Med 2019; 16: e1002848
    CrossrefPubMedGoogle Scholar
  • 66 Feig DS, Donovan LE, Zinman B. et al. Metformin in women with type 2 diabetes in pregnancy (MiTy): A multicentre, international, randomised, placebo-controlled trial. Lancet Diabetes Endocrinol 2020; 8: 834-844
    CrossrefPubMedGoogle Scholar
  • 67 Zhang R, Han S, Chen G-C. et al. Effects of low-glycemic-index diets in pregnancy on maternal and newborn outcomes in pregnant women: A meta-analysis of randomized controlled trials. Eur J Nutr 2018; 57: 167-177
    CrossrefPubMedGoogle Scholar
  • 68 Gilbert C, Valois M, Koren G. Pregnancy outcome after first-trimester exposure to metformin: A meta-analysis. Fertil Steril 2006; 86: 658-663
    CrossrefPubMedGoogle Scholar
  • 69 Norgaard SK, Nichum VL, Barfred C. et al. Use of the smartphone application “Pregnant with Diabetes”. Dan Med J 2017; 64: A5417
    PubMedGoogle Scholar
  • 70 Blumer I, Hadar E, Hadden DR. et al. Diabetes and pregnancy: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2013; 98: 4227-4249
    CrossrefPubMedGoogle Scholar
  • 71 Brown J, Ceysens G, Boulvain M. Exercise for pregnant women with preexisting diabetes for improving maternal and fetal outcomes. Cochrane Database Syst Rev 2017; 12: CD012696
    PubMedGoogle Scholar
  • 72 American Diabetes Association (ADA) 14. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes-2020. Diabetes Care 2020; 43: S183-S192
    CrossrefPubMedGoogle Scholar
  • 73 Mackensen F, Paulus WE, Max R. et al. Ocular changes during pregnancy. Dtsch Arztebl Int 2014; 111: 567-575 quiz 576
    PubMedGoogle Scholar
  • 74 Joint British Diabetes Societies for Inpatient Care (JBDS-IP). Management of glycaemic control in pregnant women with diabetes on obstetric wards and delivery units: May 2017. Retrieved from: https://www.diabetes.org.uk/professionals/resources/shared-practice/inpatient-and-hospital-care/joint-british-diabetes-societyfor-inpatient-care/management-of-glycaemic-control-in-pregnant-wo-men-with-diabetes-on-obstetric-wards-and-delivery-units; accessed: 12.07.2021
    PubMed