Among women with diabetes, the worst pregnancy outcome is seen in the subgroup of women with
diabetic nephropathy. Development of severe
preeclampsia that leads to early preterm delivery is frequent. Predictors and pathophysiological mechanisms for the development of
preeclampsia among women with diabetes and observational studies that support antihypertension treatment for pregnant women with microalbuminuria or
diabetic nephropathy preventing
preeclampsia and early preterm delivery are presented here. Obtaining and maintaining strict
glycemic control before and during pregnancy is paramount to prevent preterm delivery. The cornerstones of diabetes management are appropriate diet and
insulin, although the risk of severe
hypoglycemia always needs to be taken into account when tailoring a diabetes treatment plan. Pathophysiological mechanisms of the increased risk of
hypoglycemia during pregnancy are explored, and studies evaluating the use of
insulin analogs,
insulin pumps, and continuous
glucose monitoring to improve pregnancy outcomes and to reduce the risk of severe
hypoglycemia in pregnant women with
type 1 diabetes are reported. In addition to strict
glycemic control, other factors involved in fetal overgrowth are explored, and restricting maternal
gestational weight gain is a promising treatment area. The optimal
carbohydrate content of the diet is discussed. In summary, the lessons learned from this clinical research are that
glycemic control,
gestational weight gain, and antihypertension treatment all are of importance for improving pregnancy outcomes in pregnant women with preexisting diabetes. An example of how to use app technology to share the recent evidence-based clinical recommendations for women with diabetes who are pregnant or planning pregnancy is given.