The stakes are high when pregnancies are complicated by type 1 diabetes. In addition to the maternal risks, there are numerous fetal complications that can result from diabetes, including spontaneous abortion, fetal anomalies, neonatal birth trauma, macrosomia, neonatal hypoglycemia, hyperbilirubinemia, and fetal demise (1). Consequently, the American Diabetes Association (ADA) recommends stringent glycemic targets in pregnant women with type 1 diabetes to prevent adverse maternal and fetal outcomes.

Recommendations include self-monitoring of both fasting and postprandial blood glucose and a target A1C of <6% without significant hypoglycemia. Preprandial glucose testing is also recommended in women with pregestational diabetes using insulin pumps or basal-bolus therapy so that premeal rapid-acting insulin doses can be adjusted (2). The following individual glucose targets are recommended for type 1 diabetes: fasting glucose <90 mg/dL, 1-hour postprandial glucose <130–140 mg/dL, and 2-hour postprandial glucose <120 mg/dL (2).

These strict glycemic...

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