Pregnancy in women with pre-existing diabetes remains associated with elevated maternal and neonatal risks, particularly when glycemic control is suboptimal. Evidence from Asian populations is comparatively limited. A retrospective cohort study published in Diabetes, Obesity and Metabolism assessed maternal glycemia, management patterns, and pregnancy outcomes in a multiethnic population at a Singapore tertiary center.

The analysis included 289 pregnancies between January 1, 2022 and December 31, 2024, involving women with type 2 diabetes mellitus (T2DM, 75.8%), prediabetes (19.0%), and type 1 diabetes mellitus (T1DM, 5.2%). Median maternal age was 33 years, and median pre-pregnancy body mass index was 29.3 kg/m². Glycemic control improved over gestation, with HbA1c decreasing from 7.0% in early pregnancy to 6.1% across trimesters (p < 0.001). Macrosomia (birthweight ≥4 kg) was observed in 4.2% of infants. Preterm birth occurred more frequently in T1DM (33.3%) compared with T2DM (5.0%) and prediabetes (1.8%). Using Singapore large-for-gestational-age (LGA) standards, third-trimester HbA1c <6.5% was associated with reduced odds of LGA.

Retinopathy screening was completed in 67.6% of pregnancies, and continuous glucose monitoring or insulin pump therapy was not used. Multidisciplinary care was associated with improved glycemic indices and lower macrosomia rates; however, T1DM remained linked to higher preterm delivery and neonatal morbidity. The findings support enhanced preconception care, comprehensive retinal screening, and broader adoption of real-time continuous glucose monitoring to optimize outcomes in Asian women with pre-existing diabetes.