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WHO Releases New Guidelines for Safe Pregnancy in Women with Diabetes

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  Published in Health and Fitness on Sunday, November 16th 2025 at 1:18 GMT by TheHealthSite

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WHO Issues New Guidelines to Support Safe Pregnancy for Women With Diabetes

The World Health Organization (WHO) has released a comprehensive set of evidence‑based recommendations aimed at reducing the risks associated with pregnancy in women who have diabetes, whether type 1, type 2, or gestational diabetes. The updated guidance—published in early 2024—addresses a growing global health challenge: the rising prevalence of diabetes in women of reproductive age and the substantial maternal‑fetal complications that can arise when the disease is not optimally managed during pregnancy.

Why a New Guideline Was Needed

Over the past decade, the incidence of both pre‑existing and gestational diabetes has climbed worldwide, driven largely by increasing rates of obesity and sedentary lifestyles. In 2022, the WHO estimated that more than 425 million adults globally had diabetes, a number projected to rise to 629 million by 2045. When diabetes is present in pregnancy, the risks of miscarriage, pre‑eclampsia, stillbirth, macrosomia (a baby that is larger than normal), and neonatal hypoglycaemia double compared with the general population.

Historically, guidelines for managing diabetes in pregnancy have been fragmented, with variations across countries and limited integration with primary care. Many clinicians lack clear, up‑to‑date information on best practices, especially regarding newer technologies such as continuous glucose monitoring (CGM) and newer insulin analogues. The WHO’s new framework brings together international evidence, real‑world data, and expert consensus into a single, coherent package.

Core Components of the WHO Recommendations

1. Early Identification and Risk Stratification
   - All pregnant women, irrespective of diabetes status, should undergo screening for gestational diabetes at 12–16 weeks’ gestation, with a repeat test at 24–28 weeks if risk factors persist.
   - Women with known type 1 or type 2 diabetes should receive a pre‑conception counselling visit to optimise glycaemic control and assess for comorbidities (e.g., hypertension, kidney disease).
   - The guidelines provide an updated risk‑scoring tool incorporating age, body mass index, ethnicity, family history, and previous obstetric outcomes to identify high‑risk pregnancies early.

2. Optimised Glycaemic Targets
   - For most women with type 1 or type 2 diabetes, the target fasting glucose is 4.0–5.0 mmol/L (72–90 mg/dL), and the 2‑hour post‑prandial target is 5.6–7.8 mmol/L (100–140 mg/dL).
   - For gestational diabetes, a fasting target of 4.5–5.5 mmol/L and a 1‑hour post‑prandial target of ≤7.8 mmol/L is recommended.
   - These targets are more stringent than previous WHO recommendations and reflect evidence that tighter control reduces the incidence of macrosomia and neonatal hypoglycaemia without increasing hypoglycaemic episodes when combined with education and monitoring.

3. Use of Continuous Glucose Monitoring (CGM)
   - The new guidelines strongly endorse CGM for all women with pre‑existing diabetes and for high‑risk gestational diabetes.
   - CGM data can guide insulin titration in real time, reduce glucose variability, and improve maternal satisfaction.
   - When CGM is unavailable, SMBG (self‑monitoring of blood glucose) using a standardized testing protocol remains acceptable, but clinicians should aim to provide at least 8–12 readings per day.

4. Insulin Regimens and Technology
   - Rapid‑acting insulin analogues (e.g., insulin lispro or aspart) are recommended over NPH or regular insulin for basal‑bolus therapy.
   - Basal insulin analogues such as glargine U300 or degludec are encouraged for basal coverage.
   - The WHO underscores that the safety profile of these analogues has been confirmed in multiple pregnancy registries.

5. Multidisciplinary Care Teams
   - A team approach that includes obstetricians, endocrinologists, diabetes educators, dietitians, and midwives is essential.
   - The guidelines detail a care model in which a “diabetes‑in‑pregnancy” coordinator visits the patient weekly during the first trimester and bi‑weekly thereafter, ensuring adherence to treatment and addressing psychosocial barriers.

6. Lifestyle and Nutrition
   - Individualised dietary counselling is crucial, focusing on carbohydrate counting, glycaemic index awareness, and balanced macronutrient distribution.
   - Physical activity is encouraged, with at least 150 minutes of moderate exercise per week, adjusted for gestational stage and obstetric complications.

7. Delivery Planning and Post‑partum Care
   - Vaginal delivery is generally preferred unless obstetric indications dictate Caesarean section.
   - Post‑partum insulin adjustments should consider lactation‑related insulin sensitivity changes.
   - The WHO recommends a 12‑week postpartum glucose tolerance test to assess for persistent gestational diabetes and to identify women at risk of future type 2 diabetes.

Implications for Global Health Policy

The WHO’s guidelines are intended to be adaptable across diverse health systems, from high‑income to low‑ and middle‑income countries (LMICs). Recognizing the constraints in many LMICs—such as limited access to insulin analogues or CGM—the guidelines provide tiered recommendations. For instance, they highlight the use of inexpensive, readily available monitoring devices and the potential for community health workers to conduct basic glucose monitoring when specialist care is scarce.

Moreover, the WHO emphasizes the importance of integrating diabetes‑in‑pregnancy protocols into national maternal‑health programmes. This integration includes:

• Training of midwives and primary‑care physicians on screening protocols.
• Supply chain management to ensure steady availability of insulin and monitoring supplies.
• Use of electronic health records to track glycaemic control across prenatal visits, enabling timely interventions.

The guidelines also highlight the need for robust data collection to monitor outcomes. By encouraging the establishment of pregnancy registries and linking them to national diabetes databases, the WHO aims to create a feedback loop that can refine future recommendations.

Reactions from the Medical Community

Early responses from professional societies have been largely positive. The American Diabetes Association (ADA) praised the WHO’s focus on real‑world applicability and the inclusion of CGM as a standard of care. The International Federation of Gynecology and Obstetrics (FIGO) commended the emphasis on multidisciplinary teams and the clear pathways for care escalation.

However, some experts point out the challenges of implementing CGM universally in resource‑constrained settings. They advocate for the development of low‑cost, open‑source CGM devices and for partnerships with industry to subsidise access for pregnant women in LMICs.

Conclusion

The WHO’s new guidelines for safe pregnancy in women with diabetes represent a significant stride toward reducing maternal‑fetal morbidity and mortality. By combining stringent glycaemic targets, evidence‑based insulin strategies, and a patient‑centred multidisciplinary approach, the guidance provides a practical framework that can be tailored to diverse healthcare settings. While the adoption of advanced monitoring technologies poses challenges in some regions, the overarching principles—early detection, tight glycaemic control, and coordinated care—are universally applicable and hold promise for improving outcomes for millions of pregnant women worldwide.