Table 1 A comparison of international guidelines recommendation for preconception care among diabetes
From: Preconception care of women with diabetes: a review of current guideline recommendations
ADA 2009 | ADA 2004 | NICE 2008 | SIGN 2001 | ADIPS 2005 | |
|---|---|---|---|---|---|
Management by multidisciplinary team | ✓ | ✓ | ✓ | ✓ | |
Complete preconception evaluation of medical and obstetric history | ✓ | ✓ | |||
Evaluation and treatment of diabetic complications | |||||
retinopathy | ✓ | ✓ | ✓ | ✓ | ✓ |
nephropathy | ✓ | ✓ | ✓ | ✓ | |
neuropathy | ✓ | ✓ | ✓ | ||
cardiovascular disease | ✓ | ✓ | ✓ | ||
hypertension | ✓ | ✓ target BP should be < 140/80 | |||
Medication review | |||||
Review all current medication | ✓ | ✓ | ✓ | ✓ | |
Stop Angiotensin-Converting Enzyme (ACE) inhibitors | ✓ | ✓ | ✓ | ✓ | ✓ |
Stop Angiotensin-II Receptor Blockers (ARB) | ✓ | ✓ | ✓ | ||
Stop statins | ✓ | ✓ | ✓ | ||
Stop diuretics | ✓ | ||||
Stop β-blockers | ✓ | ✓ | ✓ | ||
Assessment of metabolic control | |||||
Measure | Use HbA1C | Use HbA1C | Use HbA1C | Use HbA1C | Use HbA1C |
Frequency of testing | 1-2 monthly | ||||
Target level | < 7% | Up to 1% above normal value, lower if possible | < 6.1% | optimised HbA1C | < 7% |
Blood glucose management | |||||
Self monitoring targets | Before meals 4.4-6.1 mmol/l, 2 hours after meal <8.6 mmol/l | Between 4 and 7 mmol/L | |||
Educate regarding hypoglycaemia awareness and management | ✓ | ✓ | |||
Prescribe insulin to achieve target blood glucose levels | ✓ | ✓ | ✓ | ✓ | ✓ |
Use metformin as an adjunct or alternative | ✓ | ✓ | ✓ | ||
Folate supplementation | |||||
Commencement | preconception | preconception | Preconception | ||
Dose | 5 mg/day | 5 mg/day | 5 mg/day | ||
Duration | until 12 weeks gestation | until 12 weeks gestation | |||
Preconception Counselling | |||||
should be routinely incorporated into diabetic care | is essential | ||||
Advise of risk of malformation with poor metabolic control and unplanned pregnancy | ✓ | ✓ | ✓ | ✓ | ✓ |
Advise use of effective contraception until good glucose control is achieved before conception | ✓ | ✓ | ✓ | ✓ | ✓ |
Inform woman about how DM affects pregnancy and how pregnancy affects DM | ✓ | ✓ | |||
Encourage smoking cessation | ✓ | ||||
Encourage reduction in alcohol intake | ✓ | ||||
Provide dietary advice | ✓ | ✓ | |||
Advice about weight reduction | Aim for a BMI < 27 | Encourage weight management and exercise | |||
Contraindications to pregnancy | HbAIC > 10% | Creatinine > 0.2 mmol/L | |||
Measure thyroid function in women with Type 1 DM | ✓ | ✓ |