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Table 3 Summary of recommendations for preconception care among diabetic women

From: Preconception care of women with diabetes: a review of current guideline recommendations

Utilise a multidisciplinary team to manage preconception care issues
Members of the team may include an obstetrician, endocrinologist, family physician, diabetic educator and dietician
Complete a full medical and obstetric evaluation in the preconception period to assess risks
Evaluate and treat diabetic complications including:
Retinopathy (pre-existing retinopathy may progress rapidly in pregnancy and should be treated first before pregnancy)
Nephropathy (patients with pre-existing microalbuminuria are more likely to develop pre-eclampsia)
Neuropathy
Cardiovascular disease
Hypertension
Review all current medication use including complementary medication and change the following to a form of therapy which has less risk:
Angiotensin-Converting Enzyme (ACE) inhibitors
Angoitensin-II Receptor Blockers (ARB)
Statins
Diuretics
β-blockers
Assess level of metabolic control
Measure HbA1C monthly until control is achieved
HbA1C should remain below 7% (1% above normal value), lower if possible
Blood glucose management
Undertake blood glucose self monitoring with targets pre-meal of 4.4-6.1 mmol/l and 2 hour after meal of < 8.6 mmol/l
Maintain blood sugar within normal range without hypoglycaemia
Educate on hypoglycaemia awareness and management
Insulin should be prescribed to achieve target blood glucose levels
Use metformin as an adjunct or alternative
Counselling
Commence folate supplementation 5 mg daily pre-conceptually until 12 weeks gestation to prevent neural tube defects
Inform about risk of miscarriage, congenital malformation and perinatal mortality with poor metabolic control and unplanned pregnancy
Inform about how DM affects pregnancy and how pregnancy affects DM
Use effective contraception until target blood glucose control is achieved before conception
Encourage smoking cessation and reduction in alcohol intake
Encourage regular exercise and management of weight to achieve a BMI < 27
Encourage diet with high levels of complex carbohydrates, soluble fibre and vitamins and reduced levels of saturated fats
Contraindications to pregnancy
HbA1C >10%
Impaired renal function, creatinine > 0.2 mmol/L (increased risk of progression to dialysis during pregnancy)
Measure thyroid function in women with Type 1 Diabetes