The Endocrine Society has released a landmark clinical practice guideline on the management of preexisting diabetes in pregnancy, addressing type 1 and type 2 diabetes from preconception through postpartum care.
The prevalence of diabetes in pregnancy is rising sharply in the last two decades, primarily due to type 2 diabetes. This guideline stresses the importance of preconception counseling, safe contraceptive use, and optimized glycemic control before and during pregnancy.

Key recommendations include discontinuation of GLP-1 receptor agonists prior to conception, consideration of metformin alongside insulin in type 2 diabetes, and tailored device selection for continuous glucose monitoring (CGM) and hybrid closed-loop (HCL) pumps. The guideline sets clear CGM targets: at least 70% of glucose readings in the 63–140 mg/dL range, with less than 25% above

Delivery decisions should balance maternal and fetal risk, with individualized timing based on glycemic control and comorbidities. There is a  need for structured endocrinologic follow-up to reduce complications, improve lactation outcomes, and support contraceptive planning, according to the new guidelines.
Research priorities include randomized trials on postpartum diabetes-focused care, cost-effectiveness studies, and evaluation of obesity and mental health interventions.

By integrating evidence-based pharmacologic strategies with cutting-edge technology, the guideline aims to reduce adverse outcomes such as preeclampsia, cesarean delivery, and neonatal complications. The Society urges clinicians to embrace individualized, technology-supported care and early intervention across the reproductive timeline to improve maternal and neonatal health outcomes.