WHO issues its first standard of care for diabetes in pregnancy, covering 21 million women

Diabetes in pregnancy affects about one in six pregnancies — roughly 21 million women a year — and until 14 November the World Health Organization had never issued a specific standard of care for it [s1].

That is the notable part of the announcement. WHO has long had guidance on diabetes and guidance on pregnancy, in the words of Director-General Tedros Adhanom Ghebreyesus, but this is the first time it has issued a specific standard of care for managing diabetes during pregnancy [s1].

What the guidelines contain

The guidelines include 27 key recommendations [s1]. WHO groups them under four emphases [s1]:

• Individualised care, covering advice on diet, physical activity and blood sugar targets.
• Monitoring: all women with diabetes should have their blood glucose checked regularly, both at clinic visits and at home.
• Personalised treatment, with specific medication regimens for type 1, type 2 and gestational diabetes where pharmacotherapy is required.
• Multidisciplinary care for women with pre-existing diabetes.

The recommendations are framed around integrating diabetes care into routine antenatal services and ensuring equitable access to essential medicines and technologies [s1].

The distinction between pre-existing and gestational diabetes runs through the document, and it is a real clinical divide rather than a bureaucratic one — a woman entering pregnancy with type 1 diabetes and a woman whose glucose tolerance shifts at 26 weeks face different risks over different timescales.

Why WHO says it matters

Diabetes in pregnancy, if not managed effectively, significantly increases the risk of life-threatening conditions including pre-eclampsia, stillbirth and birth injuries [s1]. It also carries long-term consequences, elevating the lifetime risk of type 2 diabetes and cardiometabolic disease for both mother and child [s1].

The burden is greatest in low- and middle-income countries, where access to specialised care and resources may be limited [s1]. Diabetes overall now affects over 800 million people globally, and prevalence has been rising most in low- and middle-income countries [s1].

What guidelines cannot fix

A standard of care is a specification, not a service. Every one of the four emphases assumes things that are not universally available: home glucose testing supplies for regular self-monitoring, a multidisciplinary team for women with pre-existing diabetes, a reliable supply of insulin and other medicines, and antenatal contact frequent enough for any of it to happen. WHO's own framing acknowledges this by pairing the recommendations with a call for equitable access to essential medicines and technologies [s1].

The guidelines were released on World Diabetes Day 2025, whose theme — "Diabetes across life stages" — is itself an argument for continuity of care [s1].

The postpartum question the guidelines point toward

The claim that diabetes in pregnancy raises the mother's lifetime risk of type 2 diabetes [s1] is sometimes treated as a distant statistical fact. Recent evidence suggests the divergence starts much earlier, and that it depends on which kind of gestational diabetes a woman had.

A cohort study of 1,005 women with gestational diabetes from the SWIFT study, recruited within Kaiser Permanente Northern California between 2008 and 2011, retested glucose tolerance at six to nine weeks after delivery [s2]. Women were grouped by the pattern on their diagnostic three-hour, 100-gram oral glucose tolerance test: post-load glucose intolerance only (GD-P), fasting hyperglycaemia with one post-load elevation (GD-F), or both (GD-M) [s2].

Overall, 34.5% — 347 women — had prediabetes at the postpartum test [s2]. But the rates varied widely by subtype: 23.9% (147 of 616) for GD-P, 41.9% (52 of 124) for GD-F and 55.8% (148 of 265) for GD-M [s2]. Compared with GD-P, the adjusted prevalence ratio was 1.74 (95% CI 1.36–2.24) for GD-F and 2.23 (95% CI 1.85–2.68) for GD-M, both p < .001 [s2]. GD-F and GD-M also differed from each other (adjusted prevalence ratio 1.28; 95% CI 1.01–1.61; p = .04) [s2].

This is a single integrated health system, recruited more than a decade before the WHO guidelines and using diagnostic criteria that are not universal, so the exact percentages should not be transplanted. What it establishes is directional: "gestational diabetes" is not one exposure, and more than half of one subgroup already had prediabetes within two months of giving birth [s2].

What to watch

Whether the 27 recommendations are followed by adaptation in national antenatal guidelines, and whether postpartum glucose retesting — the step at which the long-term risk becomes actionable — appears in them. A first global standard is a starting point; adoption is measured in national protocols, not launch events.

This article is informational and is not medical advice.

Sources

• WHO launches global guidelines on diabetes during pregnancy on World Diabetes Day — World Health Organization, 2025-11-14
• Early Postpartum Glucose Tolerance Reclassification by Gestational Diabetes Subtype — JAMA Network Open, 2025-11-03