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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