World Health Organization · 1st edition, 2025 · 76 pages
Evidence-based guidance on pharmacological and non-pharmacological management of type 1, type 2, and gestational diabetes in pregnancy for clinicians and policy-makers worldwide.
- Issuer
- World Health Organization
- Edition
- 1st edition, 2025
- Audience
- Policy-makers, obstetricians, endocrinologists, midwives, nurses, general practitioners, dietitians, diabetes educators, maternal and child health programme managers
- Evidence
- GRADE-rated systematic reviews; GRADE-CERQual qualitative evidence synthesis; evidence-to-decision frameworks
- Reviewed
- 14 Oct 2026 · GMJ
What this guideline says
GMJ summary
This guideline provides 27 recommendations for managing diabetes during pregnancy, covering type 1, type 2, and gestational diabetes mellitus (GDM). Approximately one in six live births globally (21 million per year) is affected by diabetes during pregnancy, with complications including pre-eclampsia, stillbirth, macrosomia, neonatal hypoglycaemia, and long-term cardiometabolic risks for both mother and child.
Core recommendations emphasise individualised dietary advice, physical activity consistent with general pregnancy guidance, self-monitoring of blood glucose for all types of diabetes, and continuous glucose monitoring specifically for type 1 diabetes. For pharmacological management, pregnant women with type 1 diabetes should continue their pre-pregnancy insulin regimen unless changes are needed for optimal control. Women with type 2 diabetes or GDM unable to achieve glycaemic targets with lifestyle measures should initiate metformin or insulin; combination therapy may be considered if monotherapy fails.
The guideline also addresses specialised multidisciplinary care (essential for type 1 and type 2 diabetes, considered for GDM), additional fetal monitoring, retinopathy screening and renal assessment for women with pre-existing diabetes, and glycaemic target individualisation. Developed using GRADE methodology with input from global experts and patient representatives, these recommendations aim to reduce preventable complications, support woman-centred care, and promote health equity across diverse settings.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Self-monitoring of blood glucose (SMBG) recommended for all pregnant women with diabetes where feasible; continuous glucose monitoring (CGM) recommended specifically for type 1 diabetes
- Glycaemic targets should be individualised; fasting plasma glucose typically 5.0–5.5 mmol/L (90–100 mg/dL) for GDM, with two-hour postprandial <6.7 mmol/L (120 mg/dL) in most studies
- For type 1 diabetes: continue pre-pregnancy insulin type and delivery method unless change needed; measure HbA1c at first antenatal contact
- For type 2 diabetes unable to achieve targets with diet/exercise: initiate metformin or insulin; consider combination if monotherapy fails; replace unsafe medications with insulin and/or metformin
- For GDM unable to achieve targets after ~2 weeks diet/exercise: initiate metformin or insulin; consider combination if monotherapy insufficient
- Blood pressure targets for women with type 1 or type 2 diabetes and impaired renal function: maintain <130/80 mmHg using pregnancy-safe antihypertensives
- Routine ultrasound before 24 weeks for all; consider early scan for type 1/type 2 diabetes with second-trimester follow-up; additional growth scans after 24 weeks as indicated
- Screen for retinopathy at antenatal care initiation in type 1/type 2 diabetes with follow-up based on progression risk; assess renal function at initiation for type 1/type 2 diabetes
Core recommendations by diabetes type
Table extracted from the guideline
| Intervention | Type 1 diabetes | Type 2 diabetes | Gestational diabetes |
|---|---|---|---|
| Glucose monitoring | SMBG + CGM recommended | SMBG recommended; CGM not routine | SMBG recommended; CGM not routine |
| HbA1c measurement | Measure at first trimester/antenatal care initiation | Measure at first trimester/antenatal care initiation | Do not routinely measure |
| First-line pharmacotherapy | Continue pre-pregnancy insulin | Metformin or insulin if diet/exercise insufficient | Metformin or insulin if diet/exercise insufficient |
| Specialised care | Deliver multidisciplinary care | Deliver multidisciplinary care | Consider multidisciplinary care based on access |
| Retinopathy screening | Screen at initiation; follow-up per risk | Screen at initiation; follow-up per risk | Do not routinely screen |
| Renal assessment | Assess at initiation; specialist follow-up if impaired | Assess at initiation; specialist follow-up if impaired | Do not routinely assess |
Source: World Health Organization, Recommendations on care for women with diabetes during pregnancy. Reproduced in summary form.
What changed in this edition
Versus the previous edition
- First comprehensive WHO guideline on diabetes management during pregnancy; supersedes 2013 diagnostic criteria publication which did not include management recommendations
- Extends 2021 WHO self-care recommendations which covered SMBG for non-pregnant populations; now includes pregnancy-specific guidance and CGM recommendations
From the guideline
Verbatim
“For pregnant women with type 1, type 2 or gestational diabetes, individualize glycaemic targets to optimize glycaemic control and improve maternal and neonatal outcomes.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As someone who has worked on maternal health systems in Georgia and the region, I recognise this guideline addresses a critical gap—we have seen diabetes prevalence climbing in the South Caucasus, yet pregnancy-specific protocols remain inconsistent across facilities. The recommendation I would emphasise to Georgian colleagues is the call for individualised glycaemic targets rather than rigid thresholds; our evidence shows that very tight targets in type 1 diabetes may increase hypoglycaemia without clear benefit, demanding clinical judgement over protocol rigidity. The realistic implementation challenge will be access: while Tbilisi tertiary centres can deliver multidisciplinary teams and CGM, rural rayons will struggle with even basic HbA1c testing and reliable insulin supply. We must prioritise strengthening primary care capacity to manage GDM and ensure referral pathways function for complicated pre-existing diabetes, rather than assuming all women can reach specialised services. Georgia's UHC programme provides a platform, but bridging the urban-rural technology and expertise gap will require deliberate, staged investment and task-sharing models the guideline appropriately acknowledges as feasible alternatives.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 14 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus, these recommendations address a significant regional burden: diabetes prevalence is rising rapidly in low- and middle-income countries, which now account for 81% of global cases. Implementation will require integration with Georgia’s Universal Health Care programme and maternal health services. Key considerations include ensuring insulin availability and affordability (the guideline notes global supply gaps particularly affecting lower-income countries), training primary care providers and obstetricians in multidisciplinary diabetes-pregnancy management, establishing CGM access where feasible, and adapting dietary and physical activity advice to local cultural contexts. Strengthening laboratory capacity for HbA1c testing and ultrasound services for fetal monitoring will be essential. The emphasis on individualised care and shared decision-making aligns with patient-centred models, though resource constraints may require prioritisation of interventions for women with pre-existing versus gestational diabetes.
Questions this guideline answers
Quick answers
What glucose-lowering medications are recommended for women with gestational diabetes who cannot control blood glucose with diet and exercise?
Metformin or insulin are recommended as first-line options. If monotherapy with either metformin or insulin is insufficient, consider combination therapy with metformin plus insulin. Evidence shows metformin reduces need for insulin initiation, large-for-gestational age, and gestational weight gain, though many women initially on metformin will eventually need insulin added.
Should pregnant women with type 2 diabetes continue metformin if they were taking it before pregnancy?
Yes, metformin can be continued during pregnancy. For women with type 2 diabetes unable to maintain optimal glucose levels with diet and exercise, either metformin or insulin is recommended. However, medications with safety concerns (such as GLP-1 receptor agonists and SGLT2 inhibitors) should be replaced with insulin and/or metformin.
How often should pregnant women with diabetes monitor blood glucose?
The guideline does not specify exact frequency as it depends on diabetes severity and available resources. Self-monitoring of blood glucose is recommended for all types of diabetes where feasible. Women with type 1 diabetes should use continuous glucose monitoring systems where available. Frequency will be higher for women using insulin or other glucose-lowering agents.
What additional fetal monitoring is needed for pregnant women with diabetes?
Perform routine ultrasound before 24 weeks for all; for type 1 or type 2 diabetes, consider performing this as early as possible with second-trimester follow-up for anatomy and growth. Consider additional growth scans after 24 weeks as indicated. For women requiring glucose-lowering medication, consider additional fetal wellbeing monitoring as indicated, based on individual clinical context and available resources.
Related on GMJ
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GMJ News coverage
- First-in-Human Trial Tests Immune-Engineered Cells for Type 1 Diabetes Without Lifelong ImmunosuppressionOct 2026
- Weight-Loss Surgery in Type 1 Diabetes: A Case That Challenges Old BoundariesAug 2026
- GLP-1 medications reduce deaths and amputations in type 2 diabetes with peripheral artery diseaseSep 2026
- Vitamin D Supplementation Could Cut Type 2 Diabetes Prevention Costs by Nearly Half, Modelling Study SuggestsAug 2026
Quality & accreditation
Other guidelines on this topic
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- Issuer
- World Health Organization
- Type
- Guideline
- Edition
- 1st edition, 2025
- Status
- Current
- Published
- 2025-11-14
- Languages
- English; translations into six UN languages planned
- Scope
- Pharmacological and non-pharmacological management of type 1, type 2, and gestational diabetes during pregnancy
- Audience
- Policy-makers, obstetricians, endocrinologists, midwives, nurses, general practitioners, dietitians, diabetes educators, maternal and child health programme managers
- Pages
- 76
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-4-011704-4
- Evidence
- GRADE-rated systematic reviews; GRADE-CERQual qualitative evidence synthesis; evidence-to-decision frameworks
- Next review
- To be determined by WHO Maternal and Perinatal Health Guideline Technical Advisory Group
- Record history
- Created 14 Oct 2026 · updated 14 Oct 2026 · next check Apr 2027
WHO recommendations on care for women with diabetes during pregnancy. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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