Periconceptional Care of Women with Diabetes Mellitus

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Pregestational diabetes is a common complication of pregnancy that can be associated with severe maternal and fetal morbidity. In addition, some women could have progression of diabetic complications secondary to pregnancy. Preconception care can significantly reduce pregnancy complications with a dramatic impact on the diabetic mother and her infant. For those women whose condition could be hastened by conception education, better understanding and an improved decision should be available to them and their families. Because unplanned pregnancy is common among diabetic women, they should be counseled early for the importance of preconception care in the progression of this disease.

Section snippets

Significance

In 1885, Le Corche [5] described, for the first time, the association between diabetes complicating pregnancy and congenital malformations. Pedersen [6] demonstrated that diabetic mothers were at high risk for birth defects. Since then, different types of malformations have been reported in infants born to diabetic women, with an estimated incidence of 6% to 10% [2]. The most commonly affected systems are cardiovascular, central nervous, gastrointestinal, genitourinary, and skeletal (Box 1) [7]

Nephropathy

Nephropathy complicates about 30% of women with type 1 DM. Overt nephropathy is defined as persistent proteinuria (more than 500 mg/24 hours of total protein or more than 300 mg/24 hours of urinary albumin excretion) observed in the first 20 weeks of pregnancy in the absence of urinary tract infection [36]. This condition is significantly correlated with the occurrence of maternal and fetal complications. Chronic hypertension and preeclampsia are observed in 40% of these subjects, retinopathy

Guidelines for preconception care

The main objectives of preconception counseling for diabetic women are the following:

  • (1)

    Folic acid administration and adequate blood glucose control before conception decrease the rate of major congenital anomalies. Monitoring HbA1c levels monthly until stable at a level of less than 1% above the upper limit of normal. Patients should also be educated regarding contraceptive use throughout this period.

  • (2)

    Evaluation with history, physical examination, and laboratory determinations for presence of

Summary

Pregestational diabetes is a common complication of pregnancy that can be associated with severe maternal and fetal morbidity. In addition, some women could have progression of diabetic complications secondary to pregnancy. Preconception care can significantly reduce pregnancy complications with a dramatic impact on the diabetic mother and her infant. For those women whose condition could be hastened by conception education, better understanding and an improved decision should be available to

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