Improving outcomes through early diagnosis and care in diabetes during pregnancy: are we doing enough?

INTRODUCTION The prevalence of preexisting type 1 and type 2 diabetes in pregnancy continues to rise, with women with type 2 facing adverse maternal and fetal outcomes comparable to those with type 1. Despite international guidelines emphasizing a comprehensive, multi-targeted approach to ensure safe pregnancy outcomes, pregnancy-related complications remain substantially elevated in this population.AREAS COVERED This perspective article examines critical issues in the management of diabetes during pregnancy, identifying key barriers and evidence-based strategies to optimize suitable care. A search of the medical literature was performed, giving priority to randomized controlled trials (RCT), systematic reviews and meta-analyses. By analyzing the current evidence, we address fundamental challenges in preconception counseling, metabolic control optimization and pharmacological management.EXPERT OPINION The knowledge of these critical points is essential to improving maternal and neonatal outcomes and to reducing predictable complications in pregnant women with preexisting diabetes.