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Review
. 2024 Jan 15;15(1):15-23.
doi: 10.4239/wjd.v15.i1.15.

Management of monogenic diabetes in pregnancy: A narrative review

Mohammad Sadiq Jeeyavudeen  1 , Sarah R Murray  2 , Mark W J Strachan  3
Affiliations
Review

Management of monogenic diabetes in pregnancy: A narrative review

Mohammad Sadiq Jeeyavudeen et al. World J Diabetes. .

Abstract

Pregnancy in women with monogenic diabetes is potentially complex, with significant implications for both maternal and fetal health. Among these, maturity-onset diabetes of the young (MODY) stands out as a prevalent monogenic diabetes subtype frequently encountered in clinical practice. Each subtype of MODY requires a distinct approach tailored to the pregnancy, diverging from management strategies in non-pregnant individuals. Glucokinase MODY (GCK-MODY) typically does not require treatment outside of pregnancy, but special considerations arise when a woman with GCK-MODY becomes pregnant. The glycemic targets in GCK-MODY pregnancies are not exclusively dictated by the maternal/paternal MODY genotype but are also influenced by the genotype of the developing fetus. During pregnancy, the choice between sulfonylurea or insulin for treating hepatocyte nuclear factor 1-alpha (HNF1A)-MODY and HNF4A-MODY depends on the mother's specific circumstances and the available expertise. Management of other rarer MODY subtypes is individualized, with decisions made on a case-by-case basis. Therefore, a collaborative approach involving expert diabetes and obstetric teams is crucial for the comprehensive management of MODY pregnancies.

Keywords: Diabetes; Glucokinase; Hepatocyte nuclear factor 1-alpha, hepatocyte nuclear factor 1-beta, and hepatocyte nuclear factor 4-alpha; Insulin; Maturity-onset diabetes of the young; Pregnancy; Sulphonylurea.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
The key process of glucose mediated insulin secretion in the pancreas. Glucose enters the cell through GLUT2 transported and gets phosphorylated to glucose-6-phosphate by glucokinase, a rate limiting step in the process.
Figure 2
Figure 2
Management of glucokinase maturity-onset diabetes of the young in pregnancy. GCK: Glucokinase; BG: Blood glucose.
See this image and copyright information in PMC

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