Table of Contents
Women with diabetes who are planning to become pregnant should receive full information and knowledge about the effect of long-standing, uncontrolled disease on pregnancy outcomes ( increases risk of large for GA baby with related birth trauma and LSCS rates, abortions, stillbirth, neonatal death, congenital anomalies ). Those risks can be reduced ( but not eliminated) with good glycemic control before and throughout pregnancy. All that should be provided through structured educational programs, for both diabetic woman and her family, before and throughout pregnancy.
They should avoid unplanned pregnancy and should use the appropriate contraceptives until all DM related issues are settled.
Few More Tips
- Weight management and diet plan : advice to lose weight if BMI >27 ( before getting pregnant)
- Folic acid( 5mg) use when start planning for pregnancy and until completing the 12th week gestation
- Advice on SMBG , ( frequency , importance and interpretation of data to optimize treatment and prevent hypos ).
- Target of A1C of < 6.5 % (=48 mmol/l ) should be attempted -provided no hypos -, and with SMBG should have FBG from 5-7 mmol/l , pre-prandial glucose 4-7 mmol/l , avoid pregnancy if A1C > 10 %
- Provide urine ketone strips and teach on how to use and interpret data , mainly when blood glucose is high , or if feels sick ( vomiting, dehydration ) .
- Medication management : when planning for pregnancy , diabetic woman should stop all anti-diabetic agents and substitute them with insulin and or/and metformin or/and glibenclamide if metformin is not enough or not tolerated . ACE I , ARBS , statins should be stopped before pregnancy . for HTN , BB , methyldopa are good substitutes.
- Renal assessment before pregnancy : if creatinine is >=120mmol/l, positive micro albuminuria or GFR < 45 …… then referral to nephrologist is necessary before discontinuing the contraceptive.
- Retinal assessment: to do it ( with dilatation ) at the pre-conception visit, if not done in the previous 6 months , and annually thereafter provided that 1st photo is normal . If she becomes pregnant, then closer follow ups for retinal view should be provided ( at booking, 28 weeks, and even sooner –at 16 weeks – if retinopathy is found ).
Unfortunately, we don’t have such structured educational programs , to be offered at preconception. We can provide some information at pre-marital counselling visits, and for diabetic ladies who only seek advice before conception.
References
NICE (2015) Diabetes in pregnancy : management of diabetes and its complications from preconception to the postnatal period ( NG3) . NICE, London .
