Preconception Care
2
Ocular Care (preconception, during pregnancy, and postpartum)
Î 1.5a. ES recommends all women with diabetes who are seeking
pregnancy have a detailed ocular assessment by a suitably trained
and qualified eye care professional in advance of withdrawing
contraceptive measures or otherwise trying to conceive (1|⊕⊕⊕⊕), and
if retinopathy is documented, the patient should be apprised of the
specific risks to her of this worsening during pregnancy. If the degree
of retinopathy warrants therapy, we recommend deferring conception
until the retinopathy has been treated and found to have stabilized.
(1|⊕⊕⊕⊕)
Î 1.5b. ES recommends women with established retinopathy be seen by
their eye specialist every trimester, then within 3 months of delivering,
and then as needed. (1|⊕
)
Î 1.5c. ES suggests pregnant women with diabetes not known to have
retinopathy have ocular assessment performed soon after conception
and then periodically as indicated during pregnancy. (2|⊕⊕
)
Renal Function (preconception and during pregnancy)
Î 1.6a. ES suggests all women with diabetes considering pregnancy
have their renal function assessed (by measuring their urine albumin-
to-creatinine ratio, serum creatinine, and estimated GFR) in advance
of withdrawing contraceptive measures or otherwise trying to
conceive. (U) ES suggests that a woman with diabetes who has a
significantly reduced GFR be assessed by a nephrologist before
pregnancy, both for baseline renal assessment and to review the
woman's specific risk of worsening renal function in the event of
pregnancy. (U)
Î 1.6b. ES suggests all women with diabetes and preconception renal
dysfunction have their renal function monitored regularly during
pregnancy. (U)
Management of Hypertension
Î 1.7a. ES recommends satisfactory BP control (<130/80 mm Hg)
be achieved and maintained before withdrawing contraception or
otherwise trying to conceive. (1|⊕⊕
)
Î 1.7b. ES recommends a woman with diabetes who is seeking
conception while taking an ACE inhibitor or ARB in almost all cases
should discontinue the medication before withdrawing contraceptive
measures or otherwise trying to conceive. (1|⊕⊕
)
