TY - JOUR
T1 - Management of type 1 diabetes in pregnancy
T2 - update on lifestyle, pharmacological treatment, and novel technologies for achieving glycaemic targets
AU - Benhalima, Katrien
AU - Beunen, Kaat
AU - Siegelaar, Sarah E.
AU - Painter, Rebecca
AU - Murphy, Helen R.
AU - Feig, Denice S.
AU - Donovan, Lois E.
AU - Polsky, Sarit
AU - Buschur, Elizabeth
AU - Levy, Carol J.
AU - Kudva, Yogish C.
AU - Battelino, Tadej
AU - Ringholm, Lene
AU - Mathiesen, Elisabeth R.
AU - Mathieu, Chantal
N1 - Funding Information: KBen received a senior clinical research fellowship from the Flemish Research Council (FWO). KBeu received a Strategic Basic Research–FWO clinical research fellowship. TB is funded in part by the Slovenian Research Agency (grant J3–0343). The funders had no role in study design, data collection, data analysis, data interpretation, or writing of this Review. We would also like to acknowledge the contribution of Professor Fiona Denison, a co-investigator on the AiDAPT study, who died in January, 2022 and who we deeply miss. Publisher Copyright: © 2023 Elsevier Ltd
PY - 2023/7/1
Y1 - 2023/7/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85163342250&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/S2213-8587(23)00116-X
DO - https://doi.org/10.1016/S2213-8587(23)00116-X
M3 - Review article
C2 - 37290466
SN - 2213-8587
VL - 11
SP - 490
EP - 508
JO - The Lancet Diabetes and Endocrinology
JF - The Lancet Diabetes and Endocrinology
IS - 7
ER -