Here is a detailed explanation of the WHO guideline “Recommendations on care for women with diabetes during pregnancy” in English, covering its titles and key details.
Purpose: To provide evidence-based, global recommendations for improving the care and health outcomes of pregnant women with diabetes (Type 1, Type 2, or Gestational Diabetes Mellitus – GDM).
Key Details and Sections
1. Introduction and Background
- Problem Significance: Diabetes is a leading noncommunicable disease (NCD). About 1 in 6 live births (21 million annually) are affected by diabetes during pregnancy.
- Risks: Diabetes in pregnancy increases the risk of serious complications for both mother (e.g., pre-eclampsia) and baby (e.g., stillbirth, birth injuries, long-term cardiometabolic disorders).
- Guideline Need: There was a critical gap in global guidance, especially for low- and middle-income countries where the burden is highest.
2. Target Audience
This guideline is intended for:
- Policy-makers and programme managers developing healthcare protocols.
- Healthcare providers directly involved in care, including obstetricians, midwives, endocrinologists, nurses, general practitioners, dietitians, and diabetes educators.
- Training institutions for developing clinical tools and curricula.
3. Development Methods
The guideline was developed rigorously, following the WHO handbook:
- Guideline Development Group (GDG): An international panel of 16 external experts, including clinicians, researchers, and a patient representative.
- Evidence Synthesis: Commissioned new systematic reviews on effectiveness, qualitative evidence on patient/provider experiences, and economic evaluations.
- Quality Assessment: Used the GRADE approach for quantitative evidence and GRADE-CERQual for qualitative evidence.
- Decision-Making: Recommendations were formulated using Evidence-to-Decision (EtD) frameworks, considering effectiveness, values, resources, equity, acceptability, and feasibility.
4. The 27 Core Recommendations
The guideline issues 27 specific recommendations, grouped into five key areas:
A. Core Practices in Care (Recommendations 1-4)
- Provide individualized advice on diet, physical activity, and weight management based on existing WHO guidance.
- Offer diabetes-specific antenatal education.
- Deliver multidisciplinary specialized care for women with Type 1 and Type 2 diabetes, and consider it for women with GDM based on access.
B. Glucose Monitoring (Recommendations 5-10)
- Recommend Self-Monitoring of Blood Glucose (SMBG) for all types of diabetes.
- Recommend Continuous Glucose Monitoring (CGM) for women with Type 1 diabetes.
- Do not routinely recommend CGM for Type 2 or GDM.
- Measure HbA1c in the first trimester for Type 1 and Type 2 diabetes, but not routinely for GDM.
- Individualize glycaemic targets for all women.
C. Pharmacological Treatment
- Type 1 Diabetes (Recommendations 11-12): Continue the same type and method of insulin delivery used before pregnancy unless a change is needed for better control.
- Type 2 Diabetes (Recommendations 13-16):
- If diet/exercise alone is insufficient, start metformin or insulin.
- If monotherapy fails, consider a combination of metformin and insulin.
- Replace medications with safety concerns in pregnancy with insulin and/or metformin.
- GDM (Recommendations 17-18):
- If diet/exercise alone is insufficient, start metformin or insulin.
- If monotherapy fails, consider a combination of metformin and insulin.
D. Additional Monitoring and Assessments (Recommendations 19-27)
- Fetal Monitoring: Perform a routine ultrasound before 24 weeks for all. For Type 1 and Type 2 diabetes, consider an early scan. Consider additional growth scans and fetal wellbeing monitoring after 24 weeks as needed.
- Retinopathy Screening: Screen women with Type 1 or Type 2 diabetes at the start of antenatal care. Do not routinely screen women with GDM.
- Renal Assessment: Assess renal function at the start of care for women with Type 1 or Type 2 diabetes and arrange specialist follow-up if needed. Do not routinely assess for GDM. For those with impaired renal function, emphasize blood pressure control and cardiovascular risk reduction.
5. Guiding Principles
- Woman-Centered Care: Focus on a positive pregnancy experience, respecting women’s values, preferences, and right to make informed decisions.
- Shared Decision-Making: Collaborative approach between healthcare providers and pregnant women.
- Life-Course Approach: Integrate diabetes care with broader maternal and child health strategies for lifelong benefits.
- Health Equity: Address the disproportionate burden in low-resource settings and barriers like cost and access.
6. Implementation and Dissemination
- The guideline will be disseminated through WHO offices, ministries of health, professional societies, and online platforms.
- It will be translated into the six official UN languages.
- Implementation considerations include: adapting recommendations to local contexts, ensuring supply of medicines, training healthcare workers, and addressing financial barriers for women.
7. Research Implications
The guideline identifies critical knowledge gaps and prioritizes future research in:
- Optimal gestational weight gain and glycaemic targets.
- Effectiveness and cost-effectiveness of CGM in Type 2 diabetes and GDM.
- Comparative effectiveness of different insulin types and delivery systems.
- Long-term effects of in-utero exposure to metformin.
- Best models for specialized and multidisciplinary care in low-resource settings.
In summary, this 2025 WHO guideline provides a comprehensive, evidence-based framework for managing diabetes in pregnancy, emphasizing individualized, respectful, and equitable care to improve health outcomes for millions of women and their babies worldwide.
