From Knowledge to Competency: Building a Stratified Training Model in Maternal–Fetal Medicine for Advanced Diabetes in Pregnancy Care

Diabetes mellitus (both preexisting and gestational) and obesity are rising globally and concomitantly, and this increase is adversely impacting pregnancies complicated by diabetes mellitus. There is a need to develop a structured framework to guide clinical scholars through the evolving evidence-based research that informs modern care of diabetes in pregnancy. The objective of this study is to create and propose an evidence-based stratified training model in maternal–fetal medicine for advanced diabetes in pregnancy care. A review of fundamental research, including landmark trials, collaborative studies, and prospective studies, was conducted along with reference to consensus-based suggested practice guidelines. These were organized into four developmental stages designed to parallel other competency domain structures for clinical scholars. The resulting stratified training model provides a structured framework for competency development in diabetes care across the reproductive lifespan. Early stages of training focus on screening, diagnosis, diet and lifestyle counseling, and antenatal/intrapartum management. Intermediate stages focus on pharmacotherapy initiation, insulin management, continuous glucose monitoring, and recognition of acute complications. The latter stages expand to complex diabetes physiology, postpartum transition, long-term metabolic risk counseling, diabetic embryopathy, and emerging therapies. Across all stages, relevant literature is emphasized to contextualize modern practice and to introduce the scholarly underpinnings of current guidelines. This tiered stratified training model offers an evidence-informed framework for diabetes care in pregnancy and will enhance trainee confidence, clinical competence, and readiness to engage with research discoveries and developments that advance modern practice in diabetes care.