Treating to Target Glycaemia in Type 2 Diabetes Pregnancy.

There is increasing awareness that in those who develop early-onset (18-39 years) adult type 2 diabetes, the increases in insulin resistance, deterioration in beta-cell and clustering of cardiovascular risk factors are particularly pronounced. Pregnant women with type 2 diabetes have additional risk factors for serious adverse pregnancy outcomes as well as added barriers regarding healthcare access before, during and after pregnancy. Compared to pregnant women with type 1 diabetes, those with type 2 diabetes are older, have higher body mass index (BMI), with more metabolic comorbidities and concomitant medications and are more likely to belong to minority ethnic groups, and live in the highest areas of socio-economic deprivation. Approximately one in seven pregnant women with type 2 diabetes (median age 34 years) were taking ACE-inhibitors, statins (13%) and/or other potentially harmful diabetes therapies (7%). Fewer than one in four were taking high dose folic acid before pregnancy suggesting that planning for pregnancy was not a priority, either for women themselves, their healthcare professionals or the healthcare system. Knowledge of the epidemiology, pathophysiology and unique management considerations of early-onset type 2 diabetes is essential to provide evidence-based care to pregnant women with type 2 diabetes. This narrative review will discuss contemporary data regarding type 2 diabetes pregnancy outcomes and the increasing recognition that different types of diabetes may require different treatment strategies before, during and after pregnancy.