Pregnancy induces profound metabolic changes that affect both maternal and fetal physiology. Early gestation is characterized by increased insulin sensitivity and maternal fat deposition, driven by elevated estrogen and progesterone levels. This anabolic phase ensures adequate energy supply for fetal growth [1].

By mid-gestation, maternal metabolism shifts to a catabolic state with heightened insulin resistance, promoting lipolysis and gluconeogenesis to sustain fetal energy demands [2].

In pregnancies complicated by type 2 diabetes mellitus (T2DM), preexisting insulin resistance is further exacerbated, while beta-cell dysfunction limits compensatory insulin secretion, worsening hyperglycemia [3]. Once considered a disease of older adults, T2DM now increasingly affects younger women due to rising obesity, sedentary lifestyle, and social disparities. Current estimates indicate over 7 % of women of reproductive age are affected [4], and T2DM complicates up to 2 % of pregnancies *[5], *[6]. Classifying newly diagnosed diabetes in pregnancy remains challenging, but women with HbA1c ≥ 48 mmol/mol or random plasma glucose ≥ 11.1 mmol/L at booking typically warrants T2DM management [7], *[8].

Early-onset T2DM is more prevalent among disadvantaged populations, many of whom present with microvascular complications by conception [9], [10], [11]. These women face significantly increased risks of pre-eclampsia, caesarean delivery, preterm birth, and neonatal complications including hypoglycemia, respiratory distress, and neonatal intensive care unit (NICU) admissions [12], [13].

Despite these risks, preconception care remains suboptimal and only a minority of women achieve optimal glycemic control before conception [10].

The TODAY study followed adolescents and young adults with T2DM over 15 years, documenting 260 pregnancies among 141 women [14]. The study revealed high rates of maternal and neonatal complications, including chronic hypertension (35 %), nephropathy (25 %) and HbA1c values above 8 % in nearly one-third of pregnancies. These conditions were associated with increased risks of pregnancy loss, preterm delivery, large for gestational age (LGA) infants, and neonatal hypoglycemia. High rates of unplanned pregnancies and gaps in preconception care were also reported, particularly in socioeconomically disadvantaged populations with limited access to specialized services.

Taken together, these findings emphasize the growing clinical burden of T2DM in pregnancy and the urgent need for early identification and tailored multidisciplinary management to optimize maternal and fetal health.