Table 3.
Summary of recommendations for preconception care among diabetic women
| Utilise a multidisciplinary team to manage preconception care issues |
|---|
| Members of the team may include an obstetrician, endocrinologist, family physician, diabetic educator and dietician |
| Complete a full medical and obstetric evaluation in the preconception period to assess risks |
| Evaluate and treat diabetic complications including: |
| Retinopathy (pre-existing retinopathy may progress rapidly in pregnancy and should be treated first before pregnancy) |
| Nephropathy (patients with pre-existing microalbuminuria are more likely to develop pre-eclampsia) |
| Neuropathy |
| Cardiovascular disease |
| Hypertension |
| Review all current medication use including complementary medication and change the following to a form of therapy which has less risk: |
| Angiotensin-Converting Enzyme (ACE) inhibitors |
| Angoitensin-II Receptor Blockers (ARB) |
| Statins |
| Diuretics |
| β-blockers |
| Assess level of metabolic control |
| Measure HbA1C monthly until control is achieved |
| HbA1C should remain below 7% (1% above normal value), lower if possible |
| Blood glucose management |
| Undertake blood glucose self monitoring with targets pre-meal of 4.4-6.1 mmol/l and 2 hour after meal of < 8.6 mmol/l |
| Maintain blood sugar within normal range without hypoglycaemia |
| Educate on hypoglycaemia awareness and management |
| Insulin should be prescribed to achieve target blood glucose levels |
| Use metformin as an adjunct or alternative |
| Counselling |
| Commence folate supplementation 5 mg daily pre-conceptually until 12 weeks gestation to prevent neural tube defects |
| Inform about risk of miscarriage, congenital malformation and perinatal mortality with poor metabolic control and unplanned pregnancy |
| Inform about how DM affects pregnancy and how pregnancy affects DM |
| Use effective contraception until target blood glucose control is achieved before conception |
| Encourage smoking cessation and reduction in alcohol intake |
| Encourage regular exercise and management of weight to achieve a BMI < 27 |
| Encourage diet with high levels of complex carbohydrates, soluble fibre and vitamins and reduced levels of saturated fats |
| Contraindications to pregnancy |
| HbA1C >10% |
| Impaired renal function, creatinine > 0.2 mmol/L (increased risk of progression to dialysis during pregnancy) |
| Measure thyroid function in women with Type 1 Diabetes |