The Journal of clinical endocrinology and metabolism最新文献

{"title":"Impact of GLP1 agonists on reproduction.","authors":"Marie Couldwell, Anna Jane Tidwell, Ann E Taylor","doi":"10.1210/clinem/dgaf401","DOIUrl":"https://doi.org/10.1210/clinem/dgaf401","url":null,"abstract":"<p><p>Obesity, in animals and humans, is associated with male and female reproductive dysfunction. Elucidating the mechanisms by which excessive weight impacts reproduction and proving that weight loss improves reproductive function has been difficult. Data in animals and humans demonstrate improvements in reproductive function after weight loss, achieved with or without GLP1 agonists. In preclinical studies there is evidence that GLP1 agonists have direct effects on the hypothalamus to stimulate luteinizing hormone (LH) secretion and direct beneficial effects on the gonads and the endometrium. Whether GLP-1 agonists provide an added direct beneficial effect on reproductive organs in humans, beyond the benefits mediated by weight loss, remains unclear. However, consideration of GLP1 agonists for the treatment for obesity-associated reproductive dysfunction requires caution, as any weight loss during pregnancy is associated with adverse fetal outcomes, and preclinical studies indicate fetal toxicity of the GLP1 agonist class. Here, we review the available pre-clinical and clinical evidence of the effects of GLP-1 agonists on human reproductive health, suggest a therapeutic strategy, and list the needs for future research.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor from Hasebe and Su: \"Plasma Proteins Predict Kidney Function Trajectories in Type 2 Diabetes\".","authors":"Masashi Hasebe, Chen-Yang Su","doi":"10.1210/clinem/dgaf405","DOIUrl":"https://doi.org/10.1210/clinem/dgaf405","url":null,"abstract":"","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter to the Editor from Hasebe and Su: \"Plasma Proteins Predict Kidney Function Trajectories in Type 2 Diabetes\".","authors":"Resham L Gurung, Huili Zheng, Jia Le Ivan Tan, Sylvia Liu, Keven Ang, Jian-Jun Liu, Thomas M Coffman, Su Chi Lim","doi":"10.1210/clinem/dgaf406","DOIUrl":"https://doi.org/10.1210/clinem/dgaf406","url":null,"abstract":"","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline.","authors":"Gail K Adler, Michael Stowasser, Ricardo R Correa, Nadia Khan, Gregory Kline, Michael J McGowan, Paolo Mulatero, M Hassan Murad, Rhian M Touyz, Anand Vaidya, Tracy A Williams, Jun Yang, William F Young, Maria-Christina Zennaro, Juan P Brito","doi":"10.1210/clinem/dgaf284","DOIUrl":"https://doi.org/10.1210/clinem/dgaf284","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Primary aldosteronism (PA), a primary adrenal disorder leading to excessive aldosterone production by one or both adrenal glands, is a common cause of hypertension. It is associated with an increased risk of cardiovascular complications compared with primary hypertension. Despite effective methods for diagnosing and treating PA, it remains markedly underdiagnosed and undertreated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To develop an updated guideline that provides a practical, clinical approach to identifying and managing PA to improve diagnosis rates and encourage targeted treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The Guideline Development Panel (GDP), composed of a multidisciplinary panel of clinical experts and experts in systemic review methodology, used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to define 10 questions related to the diagnosis and treatment of PA. Systematic reviews were conducted for each question. The GDP used the GRADE Evidence to Decision (EtD) framework to consider contextual factors, such as stakeholder values and preferences, costs and required resources, cost-effectiveness, acceptability, feasibility, and the potential impact on health equity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We suggest that all individuals with hypertension be screened for PA by measuring aldosterone and renin and determining the aldosterone to renin ratio, and that subsequent clinical care be guided by the results. We suggest that individuals with PA receive PA-specific therapy, either medical or surgical. In individuals who screen positive for PA, we suggest (1) commencement of PA-specific medical therapy in individuals who do not desire or are not candidates for surgery and in situations where the probability of lateralizing PA (excess aldosterone produced by one adrenal) is low based on screening results; and (2) aldosterone suppression testing in situations when screening results indicate an intermediate probability for lateralizing PA and individualized decision making confirms a desire to pursue eligibility for surgical therapy. In those who test positive by aldosterone suppression testing, and in those in whom screening results show a high probability of lateralizing PA (obviating the need for aldosterone suppression testing), we suggest adrenal lateralization with computed tomography scanning and adrenal venous sampling prior to deciding the treatment approach (medical vs surgical). In all individuals with PA and an adrenal adenoma, we suggest performing a 1-mg overnight dexamethasone suppression test. We suggest the use of mineralocorticoid receptor antagonists (MRAs) over epithelial sodium-channel (ENaC) inhibitors in the medical treatment of PA. We suggest the use of spironolactone over other MRAs, given its lower cost and greater availability; however, all MRAs, when titrated to equivalent potencies, are anticipated to have similar efficacy in treating PA. Thus, MRA","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testis Molecular Pathways in CAIS Unveil Testosterone/Estradiol on Germ Cell Tumor Risk in Non-Obstructive Azoospermia.","authors":"Massimo Alfano, Anna Sofia Tascini, Filippo Pederzoli, Chiara Venegoni, Irene Locatelli, Arianna Lesma, Giuseppe Fallara, Luca Boeri, Edoardo Pozzi, Fausto Negri, Maurizio Colecchia, Marina Pontillo, Francesco Montorsi, Jose Manuel Garcia-Manteiga, Andrea Salonia","doi":"10.1210/clinem/dgaf404","DOIUrl":"https://doi.org/10.1210/clinem/dgaf404","url":null,"abstract":"<p><strong>Context: </strong>Non-obstructive azoospermia (NOA) is the most severe form of male infertility affecting 1% of all men, with a clinical picture characterized by no sperm production, hyalinization of the basal membrane of the seminiferous tubules, primary hypogonadism and earlier onset of age-related comorbidities compared with fertile men. NOA is also characterized by etiologic heterogeneity and the non-genetic form has higher incidence of testicular germ cell cancer (TGCC) compared to the forms with genetic abnormalities.</p><p><strong>Objective: </strong>We aimed to establish molecular pathways in the testicular somatic cells that are either shared or specific for non-genetic and genetic forms of NOA, as Complete Androgen Insensitivity Syndrome (CAIS) and Klinefelter Syndrome (KS).</p><p><strong>Methods: </strong>Single cell RNAseq of the testicular somatic cells of an individual with CAIS, and data integration with published scRNA-seq datasets of testis with normal spermatogenesis, NOA, KS and germinal testicular cancer. Detailed clinical data of the CAIS patient, Testosterone and Estradiol levels in age-matched men (120 fertile, 155 infertile, 116 NOA, 18 KS, and 343 with TGCC).</p><p><strong>Results: </strong>In all conditions, Leydig cells are immature and senescent, but those of NOA associated with primary hypogonadism depict the highest expression of transcripts associated with the seminoma microenvironment, including estrogen-responsive genes. An oncological transcriptional signature in the Leydig cells has been confirmed at the systemic levels by showing a prognostic role of the decreasing Testosterone/Estradiol ratio for TGCC in men with non-genetic NOA.</p><p><strong>Conclusion: </strong>This study offers molecular insights into the prediction of TGCC in persons with NOA and eligibility for the use of aromatase inhibitors.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanded Steroid Profiling Identifies Novel Newborn Screening Markers for Congenital Adrenal Hyperplasia.","authors":"Mark R de Hora, Eric Thorstensen, Natasha L Heather, Benjamin Albert, Dianne Webster, Paul L Hofman","doi":"10.1210/clinem/dgaf402","DOIUrl":"https://doi.org/10.1210/clinem/dgaf402","url":null,"abstract":"<p><strong>Background: </strong>Simultaneous measurement of multiple steroids in dried bloodspots facilitates accurate newborn screening for classical CAH, although false positive tests are encountered. Some babies with milder forms of CAH, who may benefit from early detection and treatment, can be missed by screening.</p><p><strong>Objective: </strong>To evaluate a method for expanded steroid profiling in newborn screening bloodspots to identify novel sensitive and specific markers that will inform improvements for screening for CAH, and to identify the metabolic routes to excessive androgen synthesis in CAH in the newborn period.</p><p><strong>Methods: </strong>A method to measure 41 steroids by LCMSMS is described and evaluated using manufactured bloodspots and residual newborn screening specimens from 43 babies with true positive (TP), 11 babies with false negative (FN), and 389 babies with false positive (FP) screening results. Mann-Whitney analysis was used to determine if steroid measurements could distinguish between samples from babies with CAH and FP specimens.</p><p><strong>Results: </strong>The method was sufficiently precise and accurate for all steroids but was less sensitive for steroids of the mineralocorticoid pathway. Seven novel 11-oxygenated steroid markers were higher in TP and FN samples when compared to the FP group and were the most informative for screening. A most sensitive and specific marker, 21-deoxycortisone, was elevated in 52 of 53 CAH cases and was not detected in any FP specimens.</p><p><strong>Conclusions: </strong>The 11-oxygenated steroids are the most sensitive markers in dried bloodspots in the newborn period. Steroid profiling suggests that androgen excess in CAH in the newborn period is via several interconnected metabolic routes.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review Supporting the Endocrine Society Clinical Practice Guideline on Management of Primary Aldosteronism.","authors":"Magdoleen H Farah, Moustafa Hegazi, Mohammed Firwana, Mohamed Abusalih, Samer Saadi, Mohammad Al-Kordi, Arwa Elsheikh, Zhen Wang, Leslie Hassett, Irina Bancos, M Hassan Murad","doi":"10.1210/clinem/dgaf290","DOIUrl":"https://doi.org/10.1210/clinem/dgaf290","url":null,"abstract":"<p><strong>Context: </strong>Primary aldosteronism (PA) is a leading endocrine cause of secondary hypertension.</p><p><strong>Objective: </strong>To support the development of the Endocrine Society Clinical Practice Guideline on managing PA.</p><p><strong>Data source: </strong>MEDLINE, Embase, Scopus, and others were searched on October 4, 2024.</p><p><strong>Study selection: </strong>Studies were selected by pairs of independent reviewers.</p><p><strong>Data extraction: </strong>Data were extracted and appraised by pairs of independent reviewers.</p><p><strong>Data synthesis: </strong>We included 95 studies (7 randomized trials and 88 observational studies). We did not identify trials that evaluated the outcomes of PA screening. One observational study suggested that screening was associated with higher rates of using PA-specific medical therapies and better blood pressure control. Patients managed with adrenal venous sampling (vs computed tomography alone) may have a better post-adrenalectomy biochemical cure rate, but with an increased risk of adrenal hemorrhage. Two small observational studies suggested that PA-specific medical or surgical therapy was likely associated with better blood pressure control than nonspecific therapy. Small randomized trials suggested that surgical therapy may be associated with better blood pressure control than medical therapy, with a lower number and dosage of antihypertensive medications. Compared to eplerenone, spironolactone may be associated with better control of hypokalemia and a lower number and dosage of antihypertensive agents. Unsuppressed plasma renin activity was associated with better control of hypokalemia, while suppression was associated with higher risk of mortality, atrial fibrillation, and stroke (very low certainty).</p><p><strong>Conclusion: </strong>This systematic review addresses various aspects of managing PA and will support the development of the Endocrine Society guidelines.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends of Diabetes in Youth (TrenDY) during COVID-19 across the United States.","authors":"Amit Lahoti, Md Rejuan Haque, Monica E Bianco, Abha Chaudhary, Amy L Clark, Brynn E Marks, Catherina T Pinnaro, Amy S Shah, Margaret A Stefater-Richards, Vidhu V Thaker, Risa M Wolfe, Jeanie B Tryggestad","doi":"10.1210/clinem/dgaf395","DOIUrl":"https://doi.org/10.1210/clinem/dgaf395","url":null,"abstract":"<p><strong>Context: </strong>The frequency and acuity at diagnosis of youth-onset type 1 diabetes (T1D) and type 2 diabetes (T2D) was reported as higher in the first year of the COVID-19 pandemic, but it is unclear if these trends persist.</p><p><strong>Objective: </strong>To describe trends in new cases of youth-onset diabetes comparing the first 2 years of the COVID-19 pandemic with the 2 preceding years.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Setting: </strong>23 clinical centers in the US.</p><p><strong>Patients: </strong>New-onset T1D and T2D in youth between March 1,2018 and February 28,2022.Main Outcome Measures: New diagnosis of youth-onset T1D or T2D and acuity at diagnosis.</p><p><strong>Results: </strong>A total of 4,851 youth were diagnosed with T1D in the pre-pandemic period (Yr 1: March 1,2018 to February 28,2019, Yr 2: March 1,2019 to February 29,2020) and 5,955 individuals during pandemic (Yr 3: March 1,2020 to February 29,2021, Yr 4: March 1,2021 to February 28,2022), a 22.8% increase (ns). Proportion of DKA in T1D was higher during (43.41%) vs pre-pandemic (37.77%, p<0.01). For T2D, 1610 youth were diagnosed in the pre-pandemic period while 3443 patients were diagnosed with T2D during pandemic (a 114% increase). The increase in frequency of T2D attributable to pandemic from Yr 2 to Yr 3 was 76.8% (p<0.01), while the increase from Yr 3 to Yr 4 was not significant.</p><p><strong>Conclusions: </strong>In youth, the frequency of both T1D and T2D increased during the COVID-19 pandemic but was significant only for T2D. When controlled for yearly trends, only frequency of T2D increased significantly in the first year of pandemic suggesting that the pandemic environment differentially impacted rates of T1D and T2D in youth.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preexisting Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guideline.","authors":"Jennifer A Wyckoff, Annunziata Lapolla, Bernadette D Asias-Dinh, Linda A Barbour, Florence M Brown, Patrick M Catalano, Rosa Corcoy, Gian Carlo Di Renzo, Nancy Drobycki, Alexandra Kautzky-Willer, M Hassan Murad, Melanie Stephenson-Gray, Adam G Tabák, Emily Weatherup, Chloe Zera, Naykky Singh-Ospina","doi":"10.1210/clinem/dgaf288","DOIUrl":"https://doi.org/10.1210/clinem/dgaf288","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Preexisting diabetes (PDM) increases the risk of maternal and perinatal mortality and morbidity. Reduction of maternal hyperglycemia prior to and during pregnancy can reduce these risks. Despite compelling evidence that preconception care (PCC), which includes achieving strict glycemic goals, reduces the risk of congenital malformations and other adverse pregnancy outcomes, only a minority of individuals receive PCC. Suboptimal pregnancy outcomes demonstrated in real-world data highlight the need to further optimize prenatal glycemia. New evolving technology shows promise in helping to achieve that goal. Dysglycemia is not the only driver of poor pregnancy outcomes in PDM. The increasing impact of obesity on pregnancy outcomes underscores the importance of optimal nutrition and management of insulin sensitizing medications during prenatal care for PDM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To provide recommendations for the care of individuals with PDM that lead to a reduction in maternal and neonatal adverse outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The Guideline Development Panel (GDP) composed of a multidisciplinary panel of clinical experts, along with experts in guideline methodology and systematic literature review, identified and prioritized 10 clinically relevant questions related to the care of individuals with diabetes before, during and after pregnancy. The GDP prioritized randomized controlled trials (RCTs) evaluating the effects of different interventions (eg, PCC, nutrition, treatment options, delivery) during the reproductive life cycle of individuals with diabetes, including type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Systematic reviews queried electronic databases for publications related to these 10 clinical questions. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology was used to assess the certainty of evidence and develop recommendations. The approach incorporated perspectives from 2 patient representatives and considered patient values, costs and resources required, acceptability and feasibility, and impact on health equity of the proposed recommendations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In individuals with diabetes mellitus who have the possibility of becoming pregnant, we suggest asking a screening question about pregnancy intention at every reproductive, diabetes, and primary care visit. Screening for pregnancy intent is also suggested at urgent care/emergency room visits when clinically appropriate (2 | ⊕OOO). This was suggested based on indirect evidence demonstrating a strong association between PCC and both reduced glycated hemoglobin (HbA1c) at the first prenatal visit and congenital malformations.In individuals with diabetes mellitus who have the possibility of becoming pregnant, we suggest use of contraception when pregnancy is not desired (2 | ⊕⊕OO). This was suggested based on indirect evidence in women with diabetes, wh","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review Supporting the Clinical Practice Guidelines on the Management of Preexisting Diabetes and Pregnancy.","authors":"Alaa Al Nofal, Khalid Benkhadra, Alzhraa Abbas, Marie-Joy Nduwimana, Mohammad Al-Kordi, Adel Kabbara Allababidi, Jennifer Wyckoff, Annunziata Lapolla, Larry J Prokop, Zhen Wang, M Hassan Murad","doi":"10.1210/clinem/dgaf289","DOIUrl":"https://doi.org/10.1210/clinem/dgaf289","url":null,"abstract":"<p><strong>Context: </strong>Women with preexisting diabetes mellitus (PDM) are at increased risk of pregnancy-related complications.</p><p><strong>Objective: </strong>To summarize the available supporting evidence for the Endocrine Society guidelines about management of PDM in pregnancy.</p><p><strong>Data sources: </strong>MEDLINE, EMBASE, Scopus, and other sources through February 2025.</p><p><strong>Study selection: </strong>Studies were selected by pairs of independent reviewers.</p><p><strong>Data extraction: </strong>Data were extracted by pairs of independent reviewers.</p><p><strong>Data synthesis: </strong>We included 17 studies. Meta-analysis showed no significant difference between hybrid closed-loop insulin pump (HCL) and standard of care regarding time in range (TIR), time above range (TAR), and time below range (TBR). HCL had better overnight TIR and TBR. For women with type 2 diabetes mellitus (T2DM), intermittent use of continuous glucose monitoring (CGM) was not associated with a significant change in the risk of large for gestational age (LGA) neonates (2 randomized controlled trials [RCTs], 102 patients). Adding metformin to insulin was associated with a lower risk of LGA (2 RCTs, 1126 patients). Three retrospective studies (1724 patients) suggested increased neonatal complications when delivery was induced before 39 weeks of gestation (particularly before 38 weeks) in women with preexisting type 1 (T1DM) and T2DM, although this evidence was subject to likely confounding. One retrospective study showed no increase in neonatal complications with periconceptional exposure to glucagon-like peptide-1 receptor agonists. We could not identify comparative studies assessing a screening question about the possibility of pregnancy or a carbohydrate restrictive diet.</p><p><strong>Conclusion: </strong>This systematic review addresses various aspects of managing PDM in pregnancy and will support the development of the Endocrine Society guidelines.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}