Management of type 1 diabetes in pregnancy: update on lifestyle, pharmacological treatment, and novel technologies for achieving glycaemic targets

Lancet Diabetes Endocrinol. 2023 Jul;11(7):490-508. doi: 10.1016/S2213-8587(23)00116-X. Epub 2023 Jun 5.


Glucose concentrations within target, appropriate gestational weight gain, adequate lifestyle, and, if necessary, antihypertensive treatment and low-dose aspirin reduces the risk of pre-eclampsia, preterm delivery, and other adverse pregnancy and neonatal outcomes in pregnancies complicated by type 1 diabetes. Despite the increasing use of diabetes technology (ie, continuous glucose monitoring and insulin pumps), the target of more than 70% time in range in pregnancy (TIRp 3·5-7·8 mmol/L) is often reached only in the final weeks of pregnancy, which is too late for beneficial effects on pregnancy outcomes. Hybrid closed-loop (HCL) insulin delivery systems are emerging as promising treatment options in pregnancy. In this Review, we discuss the latest evidence on pre-pregnancy care, management of diabetes-related complications, lifestyle recommendations, gestational weight gain, antihypertensive treatment, aspirin prophylaxis, and the use of novel technologies for achieving and maintaining glycaemic targets during pregnancy in women with type 1 diabetes. In addition, the importance of effective clinical and psychosocial support for pregnant women with type 1 diabetes is also highlighted. We also discuss the contemporary studies examining HCL systems in type 1 diabetes during pregnancies.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Antihypertensive Agents / therapeutic use
  • Aspirin / therapeutic use
  • Blood Glucose
  • Blood Glucose Self-Monitoring
  • Diabetes Mellitus, Type 1* / drug therapy
  • Diabetes, Gestational*
  • Female
  • Gestational Weight Gain*
  • Humans
  • Infant, Newborn
  • Insulin / therapeutic use
  • Life Style
  • Pregnancy
  • Pregnancy Outcome


  • Antihypertensive Agents
  • Blood Glucose
  • Insulin
  • Aspirin