Table 1

Modifiable maternal factors and possible management strategies to target individual factors

Modifiable factorManagement strategyEvidence*
HyperglycemiaMaintaining HbA1c <6.5% (48 mmol/mol) or <6% (42 mmol/mol), where possible, before and throughout gestationStrong (3,18). Many studies have demonstrated that lower HbA1c in type 1 diabetes in pregnancy can reduce the incidence of LGA neonates.
GVReducing frequent excursions in blood glucose levelsMinimal (18,26,27). Additional prospective clinical studies are required.
Maternal obesityLosing weight before pregnancy to achieve a BMI <25 kg/m2Moderate (42,44). Studies are yet to be carried out in type 1 diabetes in pregnancy.
Gestational weight gainMinimizing weight gain throughout pregnancy to keep in line with Institute of Medicine guidelines (48)Moderate (47,49). Studies are yet to be carried out in type 1 diabetes in pregnancy.
Maternal lipid levelsLowering maternal triglyceride levels through dietary manipulationMinimal (72,73). Further prospective clinical studies are required.
  • The aim of reducing the incidence of LGA neonates in type 1 diabetes in pregnancy are outlined.

  • *The evidence is graded as minimal, moderate, or strong, where minimal indicates that supporting literature includes mechanistic or associative studies only, moderate indicates minimal evidence along with evidence in studies outside type 1 diabetes in pregnancy, and strong indicates minimal and moderate evidence as well as direct evidence from studies in type 1 diabetes in pregnancy.