1
Preconception Care
Preconception Glycemic Control
Î 1.2. ES suggests women with diabetes seeking to conceive strive to
achieve blood glucose and HbA1c levels as close to normal as possible
when they can be safely achieved without undue hypoglycemia.
(2|⊕⊕
) (see Recommendations 3.2a-d and Table 3.)
Insulin Therapy
Î 1.3a. ES recommends insulin-treated women with diabetes seeking
to conceive be treated with multiple daily doses of insulin or
continuous SC insulin infusion in preference to split-dose, premixed
insulin therapy, because the former are more likely to allow for the
achievement and maintenance of target blood glucose levels before
conception and, in the event of pregnancy, are more likely to allow
for sufficient flexibility or precise adjustment of insulin therapy.
(1|⊕⊕
)
Î 1.3b. ES suggests a change to a woman's insulin regimen, particularly
when she starts continuous SC insulin infusion, be undertaken well
in advance of withdrawing contraceptive measures or otherwise
trying to conceive to allow the patient to acquire expertise in, and the
optimization of, the chosen insulin regimen. (U)
Î 1.3c. ES suggests insulin-treated women with diabetes seeking to
conceive be treated with rapid-acting insulin analog therapy (with
insulin aspart or insulin lispro) in preference to regular (soluble)
insulin. (2|⊕⊕
)
Î 1.3d. ES suggests women with diabetes successfully using the
long-acting insulin analogs insulin detemir or insulin glargine
before conception may continue with this therapy during pregnancy.
(2|⊕⊕
)
Folic Acid Supplementation
Î 1.4. ES recommends, beginning 3 months before withdrawing
contraceptive measures or otherwise trying to conceive, a woman with
diabetes take a daily folic acid supplement to reduce the risk of neural
tube defects. (1|⊕⊕
) ES suggests a daily dose of 5 mg based on
this dose's theoretical benefits. (2|⊕⊕
)
