Table 1.
A comparison of international guidelines recommendation for preconception care among diabetes
| ADA 2009 |
ADA 2004 |
NICE 2008 |
SIGN 2001 |
ADIPS 2005 |
|
|---|---|---|---|---|---|
| Management by multidisciplinary team | ✓ | ✓ | ✓ | ✓ | |
| Complete preconception evaluation of medical and obstetric history | ✓ | ✓ | |||
| Evaluation and treatment of diabetic complications | |||||
| retinopathy | ✓ | ✓ | ✓ | ✓ | ✓ |
| nephropathy | ✓ | ✓ | ✓ | ✓ | |
| neuropathy | ✓ | ✓ | ✓ | ||
| cardiovascular disease | ✓ | ✓ | ✓ | ||
| hypertension | ✓ | ✓ target BP should be < 140/80 |
|||
| Medication review | |||||
| Review all current medication | ✓ | ✓ | ✓ | ✓ | |
| Stop Angiotensin-Converting Enzyme (ACE) inhibitors | ✓ | ✓ | ✓ | ✓ | ✓ |
| Stop Angiotensin-II Receptor Blockers (ARB) | ✓ | ✓ | ✓ | ||
| Stop statins | ✓ | ✓ | ✓ | ||
| Stop diuretics | ✓ | ||||
| Stop β-blockers | ✓ | ✓ | ✓ | ||
| Assessment of metabolic control | |||||
| Measure | Use HbA1C | Use HbA1C | Use HbA1C | Use HbA1C | Use HbA1C |
| Frequency of testing | 1-2 monthly | ||||
| Target level | < 7% | Up to 1% above normal value, lower if possible | < 6.1% | optimised HbA1C | < 7% |
| Blood glucose management | |||||
| Self monitoring targets | Before meals 4.4-6.1 mmol/l, 2 hours after meal <8.6 mmol/l | Between 4 and 7 mmol/L | |||
| Educate regarding hypoglycaemia awareness and management | ✓ | ✓ | |||
| Prescribe insulin to achieve target blood glucose levels | ✓ | ✓ | ✓ | ✓ | ✓ |
| Use metformin as an adjunct or alternative | ✓ | ✓ | ✓ | ||
| Folate supplementation | |||||
| Commencement | preconception | preconception | Preconception | ||
| Dose | 5 mg/day | 5 mg/day | 5 mg/day | ||
| Duration | until 12 weeks gestation | until 12 weeks gestation | |||
| Preconception Counselling | |||||
| should be routinely incorporated into diabetic care | is essential | ||||
| Advise of risk of malformation with poor metabolic control and unplanned pregnancy | ✓ | ✓ | ✓ | ✓ | ✓ |
| Advise use of effective contraception until good glucose control is achieved before conception | ✓ | ✓ | ✓ | ✓ | ✓ |
| Inform woman about how DM affects pregnancy and how pregnancy affects DM | ✓ | ✓ | |||
| Encourage smoking cessation | ✓ | ||||
| Encourage reduction in alcohol intake | ✓ | ||||
| Provide dietary advice | ✓ | ✓ | |||
| Advice about weight reduction | Aim for a BMI < 27 | Encourage weight management and exercise | |||
| Contraindications to pregnancy | HbAIC > 10% | Creatinine > 0.2 mmol/L | |||
| Measure thyroid function in women with Type 1 DM | ✓ | ✓ | |||