Global Inequity in Diabetes in Pregnancy Technology Needs Urgent Attention

A recent International Journal of Gynecology & Obstetrics (IJGO) commentary highlights important equity gaps in the newly released joint clinical practice guideline from the Endocrine Society and the European Society of Endocrinology on diabetes and pregnancy. The joint guideline provides a comprehensive, evidence-based framework for the management of pre-existing diabetes from preconception to the postpartum period, with a strong emphasis on technology-enabled care, including continuous glucose monitoring and hybrid closed-loop systems. However, the commentary notes that the recommendations largely reflect the realities of high-income health systems and give limited attention to the settings where most women with hyperglycaemia in pregnancy (HIP) live. Globally, nearly one in six pregnancies is affected by HIP, with over 90% of births occurring in low- and middle-income countries (LMICs). Despite this burden, implementation strategies tailored to resource-constrained health systems are largely absent from the joint guideline, limiting its applicability and potential impact in these contexts. Rather than opposing the use of diabetes technologies, the commentary advocates for context-appropriate adoption. Foundational elements such as reliable insulin supply, structured education, simplified glucose monitoring, task-sharing models and integrated antenatal care pathways are emphasised as essential steps that can enable equitable scale-up of technology over time. The authors call for a complementary global consensus supplement, led by FIGO and partners, to adapt diabetes-in-pregnancy care pathways for LMICs. Embedding equity within guideline design is essential to ensure that advances in diabetes technology translate into improved maternal and perinatal outcomes for women everywhere.