New International Consensus on Diabetes Technologies in Pregnancy

Like many areas of women’s health, diabetes and pregnancy has been underresearched, leading to a lot of unanswered questions for healthcare providers and people with type 1, type 2, and gestational diabetes who are navigating pregnancy.

Diabetes in pregnancy requires intensive glucose management to support the best possible outcomes for both mother and baby. In order to manage the risk of complications, pregnant people are advised to strive for a narrower glucose target (63-140 mg/dL) than what is typically used outside of pregnancy. Managing glucose levels within a tighter range is difficult on its own – and hormonal changes throughout pregnancy pose additional challenges.

In the past several years, new studies have been published showing significant promise for diabetes technologies – like continuous glucose monitoring (CGM) and automated insulin delivery systems (AID) – to support healthy pregnancies and address these challenges. Research suggests CGM and AID technologies can help address these challenges, with benefits including increased time in the pregnancy target range, reduced risk of large-for-gestational-age infants, and more. 

With research and technologies evolving so quickly, guidance on how to use these tools during pregnancy has fallen behind. To address this gap, diaTribe convened a panel of experts from six continents to develop a new consensus statement on diabetes technology use in pregnancy. The statement provides clear, up-to-date guidance to improve outcomes and ease the burden of managing diabetes during pregnancy – both for women who already rely on technology to support their diabetes management or who may be using tech for the first time to optimize their pregnancy outcomes. 

“It is absolutely possible to have a safe and healthy pregnancy with diabetes, and technologies can help – but these tools are often underutilized due to limited research, few devices approved for use in pregnancy, and a lack of clear guidance,” said Dr. Katrien Benhalima, endocrinologist and chair of the expert author group. “Publishing this consensus is a key step to ensuring that maternal healthcare for people with diabetes continues to improve as technologies evolve.” 

The statement provides recommendations on how to use CGM and AID during pregnancy, based on the latest research and clinical experience from experts in diabetes and pregnancy. The guidelines aim to support all healthcare providers involved in diabetes and pregnancy care – especially primary care practitioners and OBGYNs, who may be less familiar with new diabetes technologies. 

Supported by 25 organizations, experts across the globe feel these recommendations will be helpful to people with diabetes who are pregnant and their care teams. The publication includes 14 recommendations on topics including:

• How to pick the best AID device and adapt system settings for an individual’s pregnancy-specific needs
• Ways to use technology before conception, during pregnancy, during labor and delivery, and immediately postpartum
• Time in range targets for using CGM to manage gestational diabetes and type 2 diabetes during pregnancy (expanding on the 2019 targets established for type 1 diabetes) 

The expert authors seek to assure clinicians and expecting mothers that CGM and AID technologies can be safely used during pregnancy and facilitate access to these devices by helping people with diabetes and their care teams feel confident using them. The paper includes detailed charts with current systems and suggested settings to serve as a useful reference for all involved in managing diabetes during pregnancy.

The consensus also highlights areas where additional efforts and studies are needed to further clarify best practices for diabetes technology use in pregnancy and facilitate broader access to these tools. Much of what is known, particularly about using diabetes technologies for type 2 and gestational diabetes, is based on expert experience. Large, high-quality trials are still needed to confirm that the field is moving in the right direction and continuing to improve care. 

In the meantime, these recommendations will provide healthcare providers with clear, up-to-date best practices and prevent unnecessary confusion for women who are already balancing intensive diabetes management with the emotional experience of pregnancy. With better information available, more women with diabetes are likely to receive the highest standard of care with support from the latest diabetes technologies.

“Having navigated pregnancy with diabetes, I know first-hand the constant challenges of managing glucose levels and coordinating all of the medical personnel on a care team. Technologies like CGM and an insulin pump were essential for my safe and successful pregnancy, but not everyone on my care team was comfortable with them,” said Julie Heverly, vice president of the Time in Range Coalition and Patient Advocacy at The diaTribe Foundation. 

“People with diabetes deserve to know they have options for management during this critical time, and clinicians need clear guidance to support them with technologies that are evolving quickly,” Heverly said. “Considering substantial gaps still exist in diabetes and pregnancy guidelines and research, we were eager to provide expert guidance to help patients and clinicians feel informed and empowered to navigate healthy pregnancies.”

Following the release of these recommendations, the Time in Range Coalition will be working with the 25 supporting organizations to create and share quick-reference guides for healthcare professionals and resources for people with diabetes, to ensure the consensus recommendations reach those who need them most. 

Supported by ADJ Diabetes Brazil, Advanced Technologies and Treatments for Diabetes, the American Association of Clinical Endocrinology, the American College of Diabetology, the American Pharmacists Association, the Association of Diabetes Care and Education Specialists, the Australasian Diabetes in Pregnancy Society, the Australian Diabetes Society, the Australian Diabetes Educators Association, the Brazilian Diabetes Society, Breakthrough T1D, the Centre for Chronic Disease Control, Diabetes Australia, Diabetes India, the European Association for the Study of Diabetes, the European Board and College of Obstetrics and Gynaecology, the Indian College of Obstetricians and Gynaecologists, the International Association of Diabetes and Pregnancy Study Groups, the International Diabetes Federation, the International Federation of Gynaecology and Obstetrics, the Japan Diabetes Society, the Research Society for the Study of Diabetes India, the Society for Obstetric Medicine India, and the World Organisation of Family Doctors and supported by the American College of Obstetricians and Gynecologists.

Learn more about pregnancy and diabetes here:

• Managing Diabetes After a Pregnancy
• CamAPS FX: Automated Insulin for Pregnancy
• What the Future of Treating Gestational Diabetes May Look Like