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Preconception Care of Women With Diabetes

	Diabetes and Congenital Malformations

 
Major congenital malformations remain the leading cause of mortality and serious morbidity in infants of mothers with type 1 or type 2 diabetes. Several studies have established an association between elevated maternal glucose or glycohemoglobin levels during embryogenesis and high rates of spontaneous abortions and major malformations in newborns. Clinical trials of preconception care to achieve stringent blood glucose control in the preconception period and during the first trimester of pregnancy have demonstrated striking reductions in rates of malformations compared with infants of diabetic women who did not participate in preconception care. (For further discussion, see the American Diabetes Association technical review on this subject [1].) Unfortunately, unplanned pregnancies occur in about two-thirds of women with diabetes, precluding adequate preconception care and leading to a persistent excess of malformations in their infants. To minimize the occurrence of these devastating malformations, standard care for all women with diabetes who have child-bearing potential should include 1) counseling about the risk of malformations associated with unplanned pregnancies and poor metabolic control and 2) use of effective contraception at all times unless the patient is in good metabolic control and actively trying to conceive.

	DIABETES AND CONTRACEPTION

 
There are no contraceptive methods that are specifically contraindicated in women with diabetes. Thus, the selection of a method for an individual patient should be made by a provider who is familiar with contraceptive prescribing practices, using the same guidelines that apply to women without diabetes. Because unexpected failure of contraception can lead to such serious complications for the infant of a woman with diabetes, the focus should be on methods with proven high degrees of effectiveness.

	PRECONCEPTION CARE PROGRAM

 
To prevent excess spontaneous abortions and congenital malformations in infants of diabetic mothers, diabetes care and education must begin before conception. This is best accomplished by a multidisciplinary team . . . [Full Text of this Article]

	SPECIFIC GOALS OF TREATMENT

 

	INITIAL VISIT

 
Medical and obstetrical history
Physical examination
Laboratory evaluation
Management plan

	CONTINUING CARE

 

	SPECIAL CONSIDERATIONS

 
Hypoglycemia
Retinopathy
Hypertension
Nephropathy
Neuropathy
Cardiovascular disease
Early pregnancy management

	Footnotes

 

	References

 

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