A Practical Manual of Diabetes in Pregnancy

3. Auflage 2026
ISBN: 978-1-394-36207-3
Verlag: John Wiley & Sons Inc

Buch, Englisch, 496 Seiten

Updated multidisciplinary guidance on managing diabetes throughout pregnancy

Now in its Third Edition, A Practical Manual of Diabetes in Pregnancy delivers evidence-based, clinically-focused guidance across the full continuum of care of pregnant women who have diabetes. Written by an international team of specialists, this edition incorporates new evidence, emerging technologies, and current approaches to patient management that have reshaped the field since the Second Edition was published nearly a decade ago.

Each chapter opens with an illustrative case history, followed by updated subject material supplemented by figures and tables, and concludes with references highlighting the most relevant literature. New to this edition is coverage of continuous glucose monitoring, hybrid closed-loop insulin delivery systems, and the interaction of genetics and obesity with diabetes in pregnancy.

Readers will also find: - Treatment recommendations grounded in the latest research spanning preconception counseling through postnatal care and long-term maternal outcomes
- Practical guidance on optimising glycaemic control incorporating evolving technologies including continuous glucose monitoring and automated insulin delivery systems in the care of pregnant women with diabetes
- International perspectives from contributors across multiple countries and specialties offering varied approaches to common clinical challenges
- Discussion of risks associated with pregnancy complicated by diabetes and long-term implications for both maternal and neonatal health outcomes

Designed for clinical reference and trainee education alike, this manual serves obstetricians, endocrinologists, neonatologists, anaesthetists, midwives, diabetic specialist nurses, family doctors, geneticists, and trainees across these specialties who manage pregnant women with diabetes.

Autoren/Hrsg.

McCance, David

Maresh, Michael

Sacks, David A.

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Endokrinologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Gynäkologie, Geburtshilfe
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Diabetologie

Inhaltsverzeichnis

Preface xix

Foreword xx

Part 1 Introduction 1

1 Epidemiology and Public Health Issues 3

Helena E. Backman, Michael Maresh, and Stefan Jansson

Overall Prevalence 4

Prevalence of Preexisting Diabetes 4

Type 1 Diabetes 6

Type 2 Diabetes 6

Other Forms of Diabetes 6

Prevalence of Gestational Diabetes 7

Public Health Impact 8

Maternal and Neonatal Risks 8

Intergenerational and Offspring Effects 10

Global Epidemiologic Burden 10

Opportunities for Prevention and Intervention 10

Health Economic Aspects 11

Pregestational Diabetes 11

Gestational Diabetes 12

Summary 12

Future Directions 12

References 13

2 Pathophysiology of Diabetes in Pregnancy 16

Arlin Delgado and Francine Hughes

Maternal Metabolic Adaptation in Pregnancy 17

Normal Metabolic Homeostasis 17

Physiologic Adaptations in Pregnancy 18

Postabsorptive State in the Nonpregnant Individual 18

Postabsorptive State in Pregnancy 20

Postprandial State, Nonpregnant 20

Postprandial State in Pregnancy 20

Insulin Resistance in Pregnancy 21

Nutrient Excess and Metabolic Dysfunction 22

Insulin Resistance and Glucose Intolerance 22

Metabolic Plasticity in Pregnancy 23

Genomics 23

Pregestational Diabetes 24

Summary 24

Clinical Implications 25

References 26

3 The Placenta in a Diabetic Pregnancy 31

Martin Gauster and Gernot Desoye

Healthy Placenta Development 31

The Placenta in Diabetes 34

Differences Between T1D, T2D, and GDM 37

The Role of the Insulin/IGF System and Leptin on the Placenta in Diabetes 37

Insulin, IGF1, and IGF2 38

Leptin 39

Influence of Fetal Sex on Placental Function in GDM 40

Placental Methylation in Diabetes 40

Summary and Conclusions 41

Recent Advances 41

Future Directions 42

References 42

Part 2 Gestational Diabetes Mellitus 51

4 Screening and Diagnosis of Gestational Diabetes 53

Matthew Janssen and Celeste Durnwald

Introduction 54

Physiology and Definition of GDM 54

Why Screening for Gestational Diabetes is Important 54

How to Screen and Diagnose Gestational Diabetes 55

Two-Step Approach 55

One-Step Approach 56

Comparison of Methods and Society Recommendations 57

Hemoglobin A1c 57

Fasting Plasma Glucose 57

Self-Monitoring Blood Glucose 58

Risks of Gestational Diabetes Screening and Diagnosis 59

General Considerations in the Screening and Diagnosis of Gestational Diabetes 59

Diagnosis of Pregestational Diabetes 59

Whom to Screen for Gestational Diabetes 59

When to Screen for Gestational Diabetes 60

Cost of Screening for Gestational Diabetes 61

Considerations for GDM Screening and Diagnosis in Special Populations 62

Prior Bariatric Surgery 62

Further Controversies in Screening and Diagnosis of Gestational Diabetes 62

Repeat Screening/Diagnosis with Single Elevated Value on 100 g OGTT 62

Repeat Screening/Diagnosis with a Suspected LGA Fetus or Polyhydramnios 62

Conclusion 63

References 64

5 Metabolic Abnormalities in Gestational Diabetes Mellitus 68

Miya Boelling and Ravi Retnakaran

Gestational Diabetes Mellitus Is a Chronic Metabolic Disorder 69

Chronicity of the Pathophysiologic Determinants of GDM 69

Metabolic Syndrome in Women with GDM 70

Lipid Profiles in Women with GDM 71

Blood Pressure in Women with GDM 72

Inflammation in Women with GDM 73

Adipokine Dysregulation in Women with GDM 74

The Life Course Perspective 74

Conclusions and Future Directions 76

References 77

6 Obesity and Gestational Diabetes 83

Jessica Montgomery and Lorie Harper

Introduction 84

Definitions and Diagnostic Criteria 84

Obesity 84

Overt Diabetes vs. Gestational Diabetes in Pregnancy 84

Diagnostic Criteria for GDM 84

Clinical Relevance of Distinguishing GDM and Overt Diabetes 85

Epidemiology and Prevalence 85

Ethnic, Genetic, and Social Determinants of GDM 85

Ethnic, Genetic, and Social Determinants of Obesity 86

Obesity and GDM 86

Metabolic Adaptations in Normal Pregnancy 86

Pathophysiology of GDM and Obesity 87

Insulin Resistance and Secretion 87

Adipokines and Lipotoxicity 87

Placental Function and Inflammation 88

Maternal and Fetal Outcomes 89

Short-Term Outcomes 90

Long-Term Outcomes – Maternal 90

Long-Term Outcomes – Child 90

Clinical Management of Obesity in Pregnancy 91

Prediction and Prevention 91

Weight Gain Recommendations 92

Role of Pharmacotherapy: Metformin vs. Insulin 92

Postpartum Care: Screening, Weight Management, and Lactation 93

Future Directions 93

Conclusions 94

References 94

7 Management of Gestational Diabetes 98

Christine Field and Mark B. Landon

The Benefit of Treating Gestational Diabetes 99

Short-Term Outcomes 99

Long-Term Outcomes 99

Glycemic Monitoring and Targets 99

Continuous Glucose Monitoring 101

Lifestyle Intervention 101

Pharmacologic Treatment 103

Insulin Therapy 103

Oral Antidiabetes Medications 104

Glyburide 104

Metformin 104

Obstetric Management 105

Future Research 105

Multiple Choice Questions 106

References 106

8 Intervention Studies 111

Dania Pagarkar and Caroline T. Nguyen

Introduction 112

Diet 112

Carbohydrate Consistent (CC) and Low Glycemic Index (GI) Diets 112

Mediterranean Diet 112

Plant-Based/High Fiber 113

DASH Diet 114

Diet Modifiers 114

Diet Conclusion 115

Exercise 115

Sleep 116

Medications and Supplements 116

Technology 117

Conclusion 117

References 118

Part 3 General Aspects of Diabetes in Pregnancy 123

9 Preconception Care 125

Kirsten Black and Emily Hibbert

Introduction 126

Informing Women About PCC 127

Principles of Preconception Education and Management of Women with DM 128

The Preconception Visit 130

Preconception Care for Women with Obesity 130

Weight Modification and Behavior Change 133

Screening for GDM and Hypothyroidism 133

Bariatric Surgery and Preconception Weight Loss: Role and Considerations 133

Women with a Previous History of GDM or Those Who Are at Risk for Developing GDM and

T2DM 134

Challenges in the Provision of Preconception Care 135

Recent Advances 135

References 137

10 Malformations 140

Apolonia García-Patterson, Montserrat Balsells, M. Carmen Medina Mallén, and Rosa Corcoy

Epidemiology 141

Prevalence 141

Relation to Type of Diabetes 141

Pathogenesis 143

Hyperglycemia 143

Hypoglycemia 143

Ketones 143

Insulin 143

Folate 150

Obesity 150

Mediators 150

Therapies 151

ACEI and ARB 151

Statins 151

Non-insulin Antihyperglycemic Agents 151

Insulin and Insulin Analogues 152

Bariatric Surgery 152

Prevention 153

Preconception Care 153

Folic Acid (FA) Supplementation 153

Detection and Management 154

Recurrence 158

Conclusions 158

References 158

11 Type 1 Diabetes 163

Lene Ringholm, Peter Damm, and Elisabeth R. Mathiesen

Introduction 164

Glycemic Targets 164

Dietary Recommendations 165

Carbohydrate Intake 166

Gestational Weight Gain 167

Maternal Hypoglycemia 168

Diabetic Ketoacidosis 168

Sick Day Rules 169

Hypertension and Diabetic Kidney Disease 169

Diabetic Retinopathy 171

Autonomic Neuropathy 172

Intrapartum Management 172

Early Postpartum Management 173

Mobile Phone Application Technology 174

Conclusions 174

Summary of Recent Advances 174

Future Directions 174

Competing Interests 175

References 175

12 A Practical Manual of Diabetes in Pregnancy 180

Christine Newman, Aoife M. Egan, and Fidelma Dunne

Prevalence 181

Risks to the Mother and Baby 181

Prepregnancy Care 182

Glycemic Targets Before and During Pregnancy 183

Glucose-Lowering Therapies 183

Hypertension 184

Diabetic Retinopathy 185

Dyslipidemia 185

Obesity and Gestational Weight Gain 186

Hyperglycemic Emergencies in Pregnancy 187

Diabetic Ketoacidosis (DKA) 187

Hyperglycemic Hyperosmolar State (HHS) [or Hyperosmolar Hyperglycemic Nonketotic

State (HONK)] 187

Cardiovascular Disease 187

Depression 188

Family Planning 188

Early Postpartum Management 188

Commentary on Type 2 Diabetes in Pregnancy: A United States (US) Perspective 188

References 190

Part 4 Management of Diabetes in Pregnancy 193

13 Provision of Diabetes Care in Pregnancy 195

R.C. Painter, M. Sahgal, and S.E. Siegelaar

Pregestational Diabetes 197

Pathophysiology 197

Aims of Treatment 197

Treatment Considerations 197

Glucose Monitoring 197

Glucose-Lowering Treatments 205

Insulin Analogs 205

Hybrid Closed-Loop (HCL) Technology 205

Metformin 208

Additional Screening 208

Neonatal Screening 210

Induction of Labor 210

Postpartum 210

Gestational Diabetes Mellitus (GDM) 210

Pathophysiology 210

Screening for GDM 211

Early Pregnancy 211

Mid-Trimester Screening 211

Late Screening 212

Ultrasonography 212

Management of GDM 212

Glucose Monitoring 212

Medical Nutrition Therapy (MNT) 212

Physical Activity 213

Pharmacotherapy in GDM 213

Induction of Labor 213

Postpartum Screening 213

Organization of Healthcare (Pregestational and Gestational DM) 213

Multidisciplinary Health Team 213

Dietician 215

Endocrinologist 216

Diabetes Nurse/Diabetes Health Educator 216

Ophthalmologist 216

Neonatologist 216

Anaesthesiologist, Social Worker, and Translator 216

Patient Peer Groups 216

Laboratory Services 216

Siting of Care 216

Primary vs. Secondary Level 216

Group Consultations 216

Virtual Care 216

Virtual Appointments and Apps 216

Challenges in Antenatal Care Provision 217

Challenges for Healthcare Providers 217

Maternal Burden 217

Diabetes in Pregnancy Care in Low-Resource Settings 218

Future Directions 218

References 219

14 Nutrition for Diabetes in Pregnancy 226

Claire L. Meek and Cerys Deakin

Introduction 226

Case Study 1 226

General Nutrition Guidelines for Healthy Pregnancy 227

Nutrition Guidelines for Diabetes in Pregnancy 227

Optimizing Carbohydrate Intake to Improve Glycemia and Outcomes 227

Case Study 1 227

Optimal Carbohydrate Quantity and Quality 227

High-Quality Carbohydrates 227

Glycemic Index (GI) 230

Glycemic Load 230

Low-Carbohydrate Diets 230

Fiber 231

Food Pairings 231

Summary 231

Weight Management 232

Case Study 2 232

Weight Management in T1DM, T2DM, and GDM 232

T1DM 232

T2DM 232

GDM 232

Pregnancy Weight Management 233

Reconsidering Weight Loss for Pregnant Women with Diabetes 233

Recommendations for Gestational Weight Gain 233

Disputing the “Eating for Two” Myth 233

Summary 233

Prepregnancy Weight Management 235

Pharmacological and Surgical Prepregnancy Weight Loss 235

Summary 235

Postnatal Weight Management 237

Summary 237

Summary 237

Breastfeeding: Nutritional Considerations 238

Breastfeeding Benefits in General 238

Breastfeeding Benefits in Women with Diabetes 238

Weight Loss and Breastfeeding 238

Summary 239

How to Give Effective Nutritional Advice 239

General Nutrition Advice 239

Barriers to Optimal Nutrition in Pregnancy 239

Cultural Practices and Expectations 239

Pregnancy-Related Symptoms 240

Practical Barriers 240

Relationships with Food 240

Responding to Barriers with Food Swaps 240

Summary 240

Summary 241

References 242

15 Home Glucose Monitoring 245

Julie C. Søholm and Eleanor M. Scott

Self-Monitoring of Blood Glucose 246

Continuous Glucose Monitoring 246

CGM in Type 1 Diabetes Pregnancy 248

CGM in Type 2 Diabetes Pregnancy 249

CGM in GDM Pregnancy 249

CGM in Healthy Pregnancy 250

Use of CGM to Provide Remote Patient Care 250

Summary and Future Advances 250

References 251

16 Advances in Non-insulin Antihyperglycemic Pharmacotherapy Agents in Pregnancy 254

Geetha Mukerji, Jennifer Fu, and Denice S. Feig

Background 256

Metformin 256

Placental Transfer 256

Clinical Experience: Cohort Studies, Randomized Trials, and Systematic Review/

Meta-analysis 256

Ovulation Induction, Pregnancy, and Live Birth Rates 256

Congenital Anomalies 257

Women with Gestational or Type 2 Diabetes 257

Women with Polycystic Ovary Syndrome 257

Other Maternal and Neonatal Outcomes 257

Women with Type 2 Diabetes 257

Women with Gestational Diabetes Mellitus 258

Women with Polycystic Ovary Syndrome 259

Long-Term Outcomes in Metformin-Exposed Offspring In Utero 259

Use of Metformin in Pregnancy: Summary 260

Sulfonylureas and Meglitinides 261

Placental Transfer 261

Clinical Experience 261

Use of Sulfonylureas and Congenital Malformations in Women with Type 2

Diabetes 261

Use of Sulfonylureas and Perinatal Outcomes Among Women with Gestational Diabetes

Mellitus 262

Use of Sulfonylureas and Long-Term Outcomes 263

Use of Sulfonylureas During Pregnancy: Summary 263

GLP-1 Receptor Agonists 263

Congenital Anomalies 263

Summary 264

Dual GLP1 Receptor and Glucose-Dependent Insulinotropic Peptide (GIP)

Agonists 264

Dipeptidyl Peptidase-4 (DPP4) Inhibitors 265

Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors 265

Alpha-Glucosidase Inhibitors 265

PPAR-Gamma Agonists 266

Placental Transfer 266

Clinical Experience 266

Summary 267

Breastfeeding 267

Sulfonylureas 267

Metformin 267

SGLT2 Inhibitors 267

GLP-1 Receptor Agonists 268

Other Drugs 268

NAHAs and Breastfeeding Summary 268

Current International Guideline Recommendations of NAHAs in

Diabetes Management 268

Recommendations for Women with Preexisting Diabetes 268

Recommendations for Women with Gestational Diabetes 268

Recommendations for Breastfeeding 269

Multiple Choice Questions 269

References 271

17 Insulins 278

Lene Ringholm, Peter Damm, and Elisabeth R. Mathiesen

Historical 279

Insulin Administration 280

Insulin Requirements 280

Long-Acting Insulin Analogues 281

Rapid-Acting Insulin Analogues 281

Premixed Insulin 282

Initiation of Insulin Treatment in Pregnancy 282

Antenatal Steroid Treatment 283

Falling Insulin Requirements 283

Insulin Treatment During Delivery 284

A Local Plan for Preplanning Insulin Treatment During Delivery 286

Insulin Treatment Immediately After Delivery 286

Insulin Treatment and Breastfeeding 288

Conclusions 289

Summary of Recent Advances 289

Future Directions 289

Competing Interests 290

References 290

18 Hybrid Closed-Loop Insulin Delivery in Pregnancy 294

Federica Carrieri and Helen R Murphy

Introduction 295

Pregnancy-Specific HCL System 300

CamAPS FX Technology 300

Other Commercially Available HCL Systems in Pregnancy 302

Randomized Controlled Trials 303

Real-World Evidence 309

Studies During Delivery and Early Postpartum 310

Summary 312

Disclosures 313

References 313

19 Maternal and Fetal Surveillance in Pregnancies Complicated by Diabetes 317

Jenny Myers and Alice Dempsey

Background 318

Pathophysiology of Fetal Compromise in Diabetes 318

Preexisting Diabetes 319

Gestational Diabetes 320

General Maternal Surveillance 320

Patterns of Fetal Growth in Pregnancies Complicated by Diabetes 321

Fetal Macrosomia 321

Fetal Growth Restriction (FGR) 321

Current Fetal Surveillance Methods 323

Ultrasound Assessment 323

Fetal Biometry 323

Doppler Ultrasonography 323

Antenatal Cardiotocography (CTG) 326

Biophysical Profile (BPP) 326

Novel and Future Directions in Fetal Surveillance 327

Three-Dimensional (3D) Ultrasonography 327

Placental Biomarkers 328

Pregnancy-Associated Plasma Protein A (PAPP-A) 328

Placental Growth Factor (PlGF) 328

Soluble Fms-Like Tyrosine Kinase-1 (sFlt-1) 329

Continuous Glucose Monitoring (CGM) 329

Practical Approaches to the Assessment of Fetal Surveillance 329

Research Directions 329

References 330

Part 5 Delivery and Postnatal Care 337

20 Diabetes Management: Labor, Delivery, and Postdelivery 339

Background 340

Antepartum 340

Location 340

Medication Management Prior to Delivery 340

Special Consideration for Preterm Labor 340

Intrapartum 342

Scheduled Cesarean 342

Trial of Labor 343

Special Considerations for Patients Using Insulin Pumps 345

Postpartum 346

Gestational Diabetes 346

Glycemic Control for Patients with Preexisting Diabetes 346

Breastfeeding 347

Summary 347

References 348

21 Neonatal Care at Birth and Postnatally for the Infant of the Diabetic Mother 351

Allison Henry, Manoj Biniwale, and Rangasamy Ramanathan

Introduction 352

Epidemiology: Healthcare Burden 352

Pathophysiology 352

Neonatal Morbidities 353

At Delivery: Birth Asphyxia, Birth Trauma, and Shoulder Dystocia 353

Metabolic: Hypoglycemia, Hypocalcemia, Hypomagnesemia, and Hypoglycemia 354

Hypocalcemia 355

Hypomagnesemia 355

Hematologic: Polycythemia and Hyperbilirubinemia 355

Respiratory: Respiratory Distress Syndrome, Persistent Pulmonary Hypertension Due to

Hyperviscosity 357

Persistent Pulmonary Hypertension (PPHN) and Hyperviscosity 357

Cardiac: Asymmetric Septal Hypertrophy 357

Congenital Heart Disease 358

GI: Pancreatic Islet Cell and Beta Cell Hypertrophy Due to Fetal Hyperinsulinism, Feeding

Problems, and Small Left Colon 358

Renal: Renal Vein Thrombosis 358

Structural: Macrosomia, Visceral Organomegaly 358

Congenital Malformations: Transposition of Great Arteries, Truncus Arteriosus,

Double Outlet Right Ventricle, and Caudal Regression Syndrome 359

Need for Neonatal Intensive Care 359

Long-Term Morbidities 359

Efforts for Prevention of Neonatal Morbidities 360

Mortality 360

Recent Evidence and Future Directions 361

References 361

22 Care for the Patient with Diabetes in the Immediate Postpartum Period 365

Erin M. Cleary and Christina M. Scifres

Background 366

Management of Medical Therapy Immediately Postpartum 366

Type 1 Diabetes 366

Type 2 Diabetes 369

Gestational Diabetes 370

Testing for Impaired Glucose Tolerance and T2D in Individuals with Gestational

Diabetes 370

Considerations Based on Mode of Delivery 372

Medical Management of Hypertensions in Setting of T1D or T2D 372

Breastfeeding 372

Contraception Options in the Immediate Postpartum Period 373

Postpartum Depression 373

Summary and Future Directions 374

References 374

23 Postpartum Contraception for Women with Diabetes 378

Anita L. Nelson

Background 379

Medical Eligibility 380

Effectiveness 380

Promotion of Breastfeeding 382

Immediate Postpartum Initiation of Method 383

Delayed Contraceptive Initiation 386

Permanent Contraception 386

Male Methods of Permanent Contraception 386

Female Permanent Contraception 387

IUD, Implants, and Injections 387

Injectable Contraceptive 387

Progestin-Only Pills (POPs) 388

Combined Hormonal Contraceptives (CHCs) 388

Female Barrier Methods 389

Male Methods 390

Behavioral Methods 390

Fertility Awareness-Based Methods (FABM) 390

Other Behavioral Methods 391

Emergency Contraception (EC) 391

Case Follow-Up 391

Future Directions 392

Important Contraceptive Principles in Women with Diabetes 392

References 392

Part 6 Implications for the Future 397

24 Long-Term Risks for the Mother 399

Chuanyu Zhao, Wing Hung Tam, and Ronald CW Ma

Background 400

Mothers with Gestational Diabetes Mellitus 400

Long-Term Risks for Women with GDM 401

Strategies to Monitor and Reduce Long-Term Risk of GDM 402

Mothers with Type 2 Diabetes 406

Long-Term Risks for Women with T2DM 407

Strategies to Monitor and Reduce Long-Term Risk of T2DM 408

Mothers with Type 1 Diabetes 409

Summary 410

Acknowledgment 411

References Key 411

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25 Diabetes in Pregnancy: Implications for the Offspring 417

Allison L. B. Shapiro, and Dana Dabelea

Risks in the Neonatal Period 419

Macrosomia 419

Congenital Malformations 419

Neonatal Hypoglycemia 419

Respiratory Distress Syndrome 419

Risks Across the Lifespan 420

Type 2 Diabetes 420

Excess Weight and Obesity 421

Cardiovascular Risk Factors 422

Neurocognition and Neurobehavioral Disorders 422

Mechanisms of Long-Term Effects 423

Fuel-Mediated Teratogenesis 423

Epigenetic Imprinting 423

Multiple-Choice Questions 424

Abbreviations 425

References 425

26 Emerging and Future Opportunities for the Prevention and Management of Gestational

Diabetes 433

David J. Hill and Jessica L.E. Hill

Introduction 433

Dysfunctional Adaptive Metabolic Changes Lead to Gestational Diabetes Mellitus

(GDM) 435

Shortcomings in Existing GDM Prevention or Management Strategies 436

Potential Interventions to Prevent or Manage GDM 439

Nutritional Supplementation 439

Vitamin D 439

Myoinositol 440

Folic Acid 440

Magnesium 441

Microbiome Modification 441

GLP-1 443

Selective Serotonin Reuptake Inhibitors 444

Conclusions 445

Acknowledgments 446

References 446

Index 458

Über Autor(innen)

David R. McCance is Emeritus Professor and Consultant Endocrinologist at the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, and Queen’s University, Belfast. A former Clinical Lead for the Regional Diabetes in Pregnancy Service and chair of the European Diabetes in Pregnancy Study Group, he has over 250 research publications, many of which have influenced national clinical guidelines.

Michael Maresh was a Consultant Obstetrician at Manchester University NHS Foundation Trust. A past chairman of the European Diabetes in Pregnancy Study Group, he contributed to NICE guidelines and served as a member of the English National Pregnancy in Diabetes Audit Group, and has had approaching 100 peer-reviewed publications in obstetrics and diabetes management.

David A. Sacks is Adjunct Clinical Professor at the Diabetes in Pregnancy Clinic, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles. With over 100 peer reviewed publications, his honors include the Norbert Frankel lecture from the American Diabetes Association and a Lifetime Achievement Award from the North American Diabetes in Pregnancy Study Group.