Table 14.1

Checklist for preconception care for women with diabetes (15,17)

Preconception education should include:
 ☐ Comprehensive nutrition assessment and recommendations for:
  • Overweight/obesity or underweight
  • Meal planning
  • Correction of dietary nutritional deficiencies
  • Caffeine intake
  • Safe food preparation technique
 ☐ Lifestyle recommendations for:
  • Regular moderate exercise
  • Avoidance of hyperthermia (hot tubs)
  • Adequate sleep
 ☐ Comprehensive diabetes self-management education
 ☐ Counseling on diabetes in pregnancy per current standards, including: natural history of insulin resistance in pregnancy and postpartum; preconception glycemic targets; avoidance of DKA/severe hyperglycemia; avoidance of severe hypoglycemia; progression of retinopathy; PCOS (if applicable); fertility in patients with diabetes; genetics of diabetes; risks to pregnancy including miscarriage, still birth, congenital malformations, macrosomia, preterm labor and delivery, hypertensive disorders in pregnancy, etc.
 ☐ Supplementation
  • Folic acid supplement (400 μg routine)
  • Appropriate use of over-the-counter medications and supplements
Medical assessment and plan should include:
 ☐ General evaluation of overall health
 ☐ Evaluation of diabetes and its comorbidities and complications, including: DKA/severe hyperglycemia; severe hypoglycemia/hypoglycemic unawareness; barriers to care; comorbidities such as hyperlipidemia, hypertension, NAFLD, PCOS, and thyroid dysfunction; complications such as macrovascular disease, nephropathy, neuropathy (including autonomic bowel and bladder dysfunction), and retinopathy
 ☐ Evaluation of obstetric/gynecologic history, including history of: cesarean section, congenital malformations or fetal loss, current methods of contraception, hypertensive disorders of pregnancy, postpartum hemorrhage, preterm delivery, previous macrosomia, Rh incompatibility, and thrombotic events (DVT/PE)
 ☐ Review of current medications and appropriateness during pregnancy
Screening should include:
 ☐ Diabetes complications and comorbidities, including: comprehensive foot exam; comprehensive ophthalmologic exam; ECG in women starting at age 35 years who have cardiac signs/symptoms or risk factors, and if abnormal, further evaluation; lipid panel; serum creatinine; TSH; and urine protein-to-creatinine ratio
 ☐ Anemia
 ☐ Genetic carrier status (based on history):
  • Cystic fibrosis
  • Sickle cell anemia
  • Tay-Sachs disease
  • Thalassemia
  • Others if indicated
 ☐ Infectious disease
  • Neisseria gonorrhea/Chlamydia trachomatis 
  • Hepatitis C
  • HIV
  • Pap smear
  • Syphilis
Immunizations should include:
 ☐ Rubella
 ☐ Varicella
 ☐ Hepatitis B
 ☐ Influenza
 ☐ Others if indicated
Preconception plan should include:
 ☐ Nutrition and medication plan to achieve glycemic targets prior to conception, including appropriate implementation of monitoring, continuous glucose monitoring, and pump technology
 ☐ Contraceptive plan to prevent pregnancy until glycemic targets are achieved
 ☐ Management plan for general health, gynecologic concerns, comorbid conditions, or complications, if present, including: hypertension, nephropathy, retinopathy; Rh incompatibility; and thyroid dysfunction
  • DKA, diabetic ketoacidosis; DVT/PE, deep vein thrombosis/pulmonary embolism; ECG, electrocardiogram; NAFLD, nonalcoholic fatty liver disease; PCOS, polycystic ovary syndrome; TSH, thyroid-stimulating hormone.