Table 3.

Options for pregnancy management in patients with HNF4A–, GCK-, and HNF1A–maturity-onset diabetes of the young

MODY type	Before pregnancy	First trimester	Second trimester	Third trimester	Management
HNF4A–MODY	Option 1 (to be preferred): switch from sulphonylurea to insulin	Continue insulin			1. Fetal growth assessment with ultrasound at 2-week intervals after 28 weeks 2. Elective caesarean section or induction of labor between 35 and 38 weeks 3. Switch to previous sulphonylurea once breastfeeding is completed 4. Monitor neonatal glycemia
	Option 2: continue sulphonylurea medication and switch to insulin during pregnancy	Continue sulphonylurea	Switch from sulphonylurea to insulin	Continue insulin
GCK–MODY	Usually no treatment	Mother and fetus carry a GCK mutation: no treatment is needed			No additional management is required
		Mother carries a GCK mutation: large dose (>1 IU/kg/day) of insulin is recommended			1. Induction at 38 weeks 2. Monitor neonatal glycemia
HNF1A–MODY	Option 1 (to be preferred): switch from sulphonylurea to insulin	Continue insulin			1. Fetal growth assessment with ultrasound at 2-week intervals after 28 weeks 2. Elective caesarean section or induction of labor between 37 and 39 weeks 3. Switch to previous sulphonylurea once breastfeeding is completed
	Option 2: continue on sulphonylurea and switch to insulin during pregnancy	Continue sulphonylurea	Switch from sulphonylurea to insulin	Continue insulin

HNF1A/4A Hepatocyte nuclear factor-1/4-alpha, GCK glucokinase