Researchers studied 27 women with two rare types of genetic diabetes (GCK and HNF1A) who were pregnant or planning to become pregnant. These special types of diabetes are caused by changes in specific genes and need different treatment than regular diabetes. The study found that when doctors switched all these women to insulin during pregnancy and monitored them carefully, both mom and baby stayed healthy. Most pregnancies went well, with very few complications. This research helps doctors understand how to safely care for pregnant women with these rare genetic forms of diabetes.

The Quick Take

  • What they studied: How doctors should treat and manage two rare types of genetic diabetes (GCK and HNF1A) during pregnancy, and whether babies and mothers stay healthy with this care
  • Who participated: 27 women with rare genetic diabetes (14 with GCK type, 13 with HNF1A type) who were pregnant or had been pregnant. They were around 31-32 years old on average and came from different backgrounds.
  • Key finding: When all pregnant women with these rare genetic diabetes types were treated with insulin and monitored regularly, both mothers and babies had good outcomes. Only 2 miscarriages occurred in the HNF1A group and 1 baby had low blood sugar briefly in the GCK group—very few problems overall.
  • What it means for you: If you have one of these rare genetic types of diabetes and are pregnant or planning pregnancy, insulin therapy with regular doctor visits appears to be a safe and effective approach. However, this research is from a small group, so talk with your doctor about your specific situation.

The Research Details

Researchers looked back at medical records from 27 women who had 36 pregnancies total. They compared two groups: women with GCK-hyperglycemia (a type where the body doesn’t recognize high blood sugar properly) and women with HNF1A-MD (a different genetic type). They tracked what treatments doctors used, how well blood sugar was controlled using a test called HbA1c, and what happened to the mothers and babies during and after pregnancy.

The study collected information before pregnancy, during each trimester (three-month period), and after delivery. They measured blood sugar levels, looked at what medicines were used, and recorded any problems that happened. This approach let researchers see patterns in how these pregnancies were managed and what the results were.

These two rare genetic types of diabetes are different from regular type 1 or type 2 diabetes, so they might need different treatment plans. Pregnancy is already a time when blood sugar control becomes more challenging for anyone with diabetes. Understanding how to safely manage these specific genetic types during pregnancy is important because there aren’t many guidelines yet. This research helps fill that gap.

This study looked at real patient records, which is good for understanding what actually happens in doctor’s offices. However, the group was relatively small (27 women), so the results might not apply to everyone. The researchers didn’t randomly assign people to different treatments, which means some differences between groups might be due to other factors. The study was done at specialized centers that focus on diabetes, so results might be different in other hospitals. Despite these limitations, the detailed tracking of pregnancies and outcomes provides useful real-world information.

What the Results Show

All 36 pregnancies were managed with insulin therapy during pregnancy, even though some women with GCK-hyperglycemia had only needed diet changes before getting pregnant. Blood sugar control was generally good during pregnancy in both groups, staying within recommended ranges. The HNF1A group had slightly better blood sugar control in the middle of pregnancy compared to the GCK group.

Most importantly, pregnancy outcomes were very good in both groups. Out of 36 pregnancies, only 2 ended in miscarriage (both in the HNF1A group), and only 1 baby had a brief episode of low blood sugar after birth (in the GCK group). All other pregnancies resulted in healthy babies and healthy mothers. No mothers developed serious pregnancy complications related to their diabetes.

Before pregnancy, women with GCK-hyperglycemia had slightly higher fasting blood sugar levels (the level when you haven’t eaten for a while) compared to the HNF1A group. Women with HNF1A had been living with their diabetes diagnosis longer on average (about 8 years versus 3.5 years). Before pregnancy, most women with GCK-hyperglycemia were managing with diet alone, while most women with HNF1A were already using insulin. During pregnancy, all women switched to insulin, and this change appeared to work well for both groups.

This is one of the first studies to directly compare how these two specific genetic types of diabetes do during pregnancy. Previous research on genetic diabetes in pregnancy is very limited. The finding that insulin therapy works well for both types during pregnancy is helpful because it gives doctors a clear approach. However, some newer research suggests that people with GCK-hyperglycemia might not always need insulin, so this study’s approach of giving everyone insulin during pregnancy is more cautious than some emerging guidelines.

The study included only 27 women, which is a small number for drawing broad conclusions. All the women were treated at specialized diabetes centers, so results might be different for women treated at regular hospitals. The study didn’t test the babies’ genes to confirm they inherited the diabetes gene, which might have affected some results. The researchers didn’t randomly assign women to different treatments, so some differences between groups might be due to other factors besides the type of diabetes. The study looked backward at medical records rather than following women forward, which can sometimes miss important details.

The Bottom Line

If you have GCK-hyperglycemia or HNF1A genetic diabetes and are pregnant or planning pregnancy: (1) Work with an endocrinologist (diabetes specialist) who has experience with genetic diabetes—HIGH CONFIDENCE; (2) Expect to use insulin during pregnancy even if you weren’t using it before—HIGH CONFIDENCE; (3) Plan for frequent blood sugar monitoring and regular doctor visits—HIGH CONFIDENCE; (4) Discuss your specific situation with your doctor, as treatment may vary based on individual factors—MODERATE CONFIDENCE.

This research is most relevant for women with GCK-hyperglycemia or HNF1A genetic diabetes who are pregnant, planning to become pregnant, or considering pregnancy. Partners and family members should also understand this information to provide support. Healthcare providers managing these patients should be aware of these findings. Women with regular type 1 or type 2 diabetes should follow different guidelines, though some principles may overlap.

Blood sugar control typically improves within days to weeks of starting insulin therapy. Babies born to mothers with well-controlled blood sugar during pregnancy generally have better outcomes immediately after birth. The long-term health benefits of good blood sugar control during pregnancy for both mother and baby develop over months and years.

Want to Apply This Research?

  • Log daily fasting blood sugar readings and HbA1c test results every 4-6 weeks. Track insulin doses used and any adjustments made by your doctor. Note any symptoms of low or high blood sugar.
  • Set reminders for regular insulin injections at the same times each day. Schedule and attend all prenatal appointments and diabetes check-ups. Keep a food diary to identify patterns affecting blood sugar. Report any unusual blood sugar readings to your doctor promptly.
  • Create a dashboard showing blood sugar trends over weeks and months. Compare your readings to target ranges set by your doctor. Track correlation between meals, activity, stress, and blood sugar levels. Share reports with your healthcare team during appointments to guide treatment adjustments.

This research describes medical management of rare genetic forms of diabetes during pregnancy. It is not a substitute for professional medical advice. If you have GCK-hyperglycemia or HNF1A genetic diabetes and are pregnant or planning pregnancy, consult with your endocrinologist and obstetrician before making any changes to your treatment plan. Individual circumstances vary, and your doctors need to know your complete medical history to provide appropriate care. This summary is based on a study of 27 women; results may not apply to all individuals. Always follow your healthcare provider’s recommendations for your specific situation.