New Guidelines Recommend Diabetes Screening for Women Planning Pregnancy

In a significant advance for women's health, a joint guideline released on July 13, 2025, by the Endocrine Society and the European Society of Endocrinology (ESE) advocates for women with diabetes to be screened for intent to conceive at every healthcare visit. This recommendation aims to enhance preconception care, thereby mitigating the health risks associated with pregnancy in women suffering from diabetes.

The guidelines highlight the increasing prevalence of diabetes among women of reproductive age, emphasizing the need for proactive management of blood sugar levels before, during, and after pregnancy. According to Dr. Jennifer Wyckoff, M.D., Guideline Chair and an endocrinologist at the University of Michigan, "In addition to preconception planning, the guideline discusses advances in diabetes technology, delivery timing, medications, and diet."

Historically, women with pre-existing diabetes have faced elevated risks during pregnancy, including miscarriages and congenital abnormalities. These risks are often linked to modifiable factors such as maternal blood sugar levels and body mass index (BMI). By initiating conversations about reproductive intentions at every visit, healthcare providers can ensure appropriate preconception care is provided, potentially reducing adverse outcomes.

The Clinical Practice Guideline, titled "Preexisting Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guideline," was published in both The Journal of Clinical Endocrinology & Metabolism and the European Journal of Endocrinology, and presented at the ENDO 2025 annual meeting in San Francisco.

Among the key recommendations are: 1. **Screening**: Healthcare providers should inquire about the pregnancy intentions of all women with diabetes of reproductive age during every visit. 2. **Delivery Timing**: Pregnant individuals with diabetes should aim for delivery before 39 weeks, as the risks associated with prolonged pregnancy may surpass those of early delivery. 3. **Medication Management**: It is recommended to discontinue anti-obesity medications known as GLP-1s prior to conception and to avoid prescribing metformin in pregnant individuals already on insulin. 4. **Diabetes Technology**: The guideline suggests the use of hybrid closed-loop systems for managing type 1 diabetes in pregnant individuals. 5. **Contraception**: Women with diabetes are advised to utilize contraception until they are ready to conceive.

These recommendations stem from a comprehensive review of existing literature and emphasize the necessity for further research into preconception care. Dr. Annunziata Lapolla, M.D., Co-chair and an expert from the University of Padova, noted, "The panel prioritized randomized controlled trials (RCTs) and employed the GRADE methodology to assess evidence certainty and guide recommendations."

The importance of addressing the nutrition and therapeutic approaches for women with obesity-related type 2 diabetes is also underscored, given the rising incidence of this condition globally.

The writing committee included experts from various institutions, including Linda A. Barbour from the University of Colorado, Florence M. Brown from Joslin Diabetes Center, and Patrick M. Catalano from Massachusetts General Hospital. They collectively reaffirmed the need for comprehensive, evidence-based guidelines to assist clinicians in managing endocrine-related health issues effectively.

The Endocrine Society, founded over a century ago, is dedicated to hormone research and the healthcare of individuals with hormone-related conditions, boasting over 18,000 members worldwide. The organization emphasizes that the development of these guidelines was achieved without corporate sponsorship, ensuring objectivity and integrity in their recommendations.

As diabetes rates continue to rise, particularly among women of childbearing age, these guidelines represent a crucial step toward improving maternal and fetal health outcomes. The proactive management of diabetes through screening for pregnancy intentions could significantly enhance care for this vulnerable population, ultimately leading to healthier pregnancies and families.