WHO issues new guidelines to improve care for diabetes in pregnancy

With diabetes complicating millions of pregnancies each year, the WHO outlines new global guidance on diet, monitoring and treatment to improve safety for mothers and babies

Pregnancy changes almost everything about metabolism, and diabetes pushes those changes into more sensitive territory. The WHO points out that one in six live births globally is now affected by diabetes in pregnancy, whether pre-existing type 1 or type 2 diabetes, or gestational diabetes that first appears during pregnancy.  According to WHO, poorly controlled glucose levels can increase the risk of pre-eclampsia, stillbirth, birth injuries, neonatal hypoglycaemia, and raise long-term risks such as cardiometabolic disorders in both mother and child.

What should women with diabetes do during pregnancy?

The WHO says women should not go for crash diets and must stay aware from complicated hacks. It calls for a personalised plan grounded in healthy eating, safe physical activity, and appropriate weight gain. The guidance emphasises:

• whole grains, vegetables, fruits and pulses
• fats mainly from unsaturated sources
• reduced sugars and minimal trans fats
• at least 150 minutes a week of moderate activity like walking, swimming, prenatal workouts

And importantly, everything must be individualised. No two pregnancies (or bodies) behave alike when diabetes enters the picture.

Why do women with diabetes need more antenatal education?

The new recommendations call for dedicated education on how diabetes affects pregnancy, how to manage glucose, why extra foetal monitoring might be needed, and what healthy weight gain looks like.

Why is specialised care necessary for diabetic pregnancies?

For type 1 and type 2 diabetes, WHO recommends a specialised, multidisciplinary team. That may include obstetricians, endocrinologists, dietitians, diabetes educators and mental health support. These pregnancies are inherently more complex, and integrated care improves outcomes.

 

For gestational diabetes, specialised care is recommended where available, acknowledging the realities of health systems in low- and middle-income settings.

How should blood glucose be monitored during pregnancy?

• For all types of diabetes: self-monitoring of blood glucose (SMBG) is recommended.
• For type 1 diabetes: continuous glucose monitoring (CGM) is encouraged where feasible.
• For type 2 diabetes and gestational diabetes: CGM is not routinely recommended, largely due to resource constraints and limited added benefit.

Monitoring frequency still depends on individual needs, medication use and glycaemic patterns.

What about medications like insulin or metformin?

• Type 1 diabetes: continue the same insulin type and delivery method unless clinically necessary to change.
• Type 2 diabetes: start metformin or insulin if diet and activity alone do not keep glucose in check. Combination therapy can be considered if single agents fall short.

Gestational diabetes: metformin or insulin is recommended when lifestyle changes are not enough.

What additional monitoring is recommended during pregnancy?

Beyond routine care, the guidelines recommend:

• an early ultrasound (preferably before 24 weeks)
• anatomy and growth scans
• foetal wellbeing checks for those on glucose-lowering medications
• eye screening for type 1 and type 2 diabetes
• kidney assessments for the same group

As the global burden of diabetes rises, WHO calls for stronger, more coordinated pregnancy care that puts women’s needs at the centre, from early screening and personalised glucose targets to accessible counselling and specialised support.

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This content is for informational purposes only and is not a substitute for professional medical advice.