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Diabetes and Pregnancy

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Key Points Î Maternal hyperglycemia in the first few weeks of pregnancy increases the risk of fetal malformations, spontaneous abortions, and perinatal mortality. Î There is a continuous graded relationship between higher maternal glucose and increasing frequency of caesarian section, preeclampsia, fetal macrosomia, and fetal morbidity. Î Before conception, glycemic control should be as close to normal as possible when this can be safely achieved. Î At the first prenatal visit (before 13 weeks gestation or as soon as possible thereafter) all women not known to already have diabetes should be tested for diabetes. Î At 24-28 weeks gestation, all pregnant women not known to already have gestational or overt diabetes should be tested for gestational diabetes. Preconception Care of Women with Diabetes Î 1.1. The Endocrine Society (ES) recommends preconception counseling be provided to all women with diabetes who are considering pregnancy. (1|⊕⊕ ) • Preconception counseling can optimally be provided by a multidisciplinary team that includes the diabetes specialist, diabetes educator, dietitian, obstetrician, and other healthcare providers, as indicated. • If possible, and with the patient's consent, the woman's partner can be included as part of a supportive and mentoring therapeutic relationship. • Preconception counseling should include a discussion regarding : ▶ the need for pregnancy to be planned and to occur only when the woman has sufficient glycemic control, has had appropriate assessment and management of comorbidities including hypertension and retinopathy, has discontinued potentially unsafe (during pregnancy) medications, and has been taking appropriate folate supplementation beforehand ▶ the importance of smoking cessation ▶ the major time commitment and effort required by the patient in both self-management and engagement with the healthcare team, both before conception and during pregnancy ▶ the importance of notifying the healthcare team without delay in the event of conception. Preconception Care

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