Preconception Care for Women with Diabetes

Do you have a case of “baby fever”? If you are thinking about starting a family, you may be surprised to learn that nearly half of all pregnancies in the U.S. are unplanned.

Preconception care is imperative when you have a chronic condition such as diabetes (type 1 or type 2). The 2015 Standards of Medical Care in Diabetes recommends that all women, with diabetes, of childbearing years be counseled on the importance of strict glycemic control prior to conception. A pregnancy that occurs under conditions of poor glycemic control increases the risk of:

  • Miscarriage
    • Spontaneous loss of fetus before the 20th week of pregnancy
  • Intrauterine fetal demise
    • Fetal death occurring after the 20th week of pregnancy
  • Fetal anomalies
    • Birth defects
  • Preeclampsia
    • High blood pressure that occurs during pregnancy along with possible fluid retention and protein in the urine.
    • Preeclampsia is pregnancy can lead to life threatening condition know as eclampsia.
  • Macrosomia
    • “Big Baby”
    • A macrosomic infant has a birth weight greater than 8 pounds 13 ounces.
    • Having a macrosomic baby can result in a traumatic delivery and increase the chances that a cesarean delivery will be required.
    • The infant may also be at risk of hypoglycemia and hyperbilirubiemia.
  • Neonatal hypoglycemia
    • A low blood sugar that occurs in the first few days of life.
    • Neonatal hypoglycemia may result in impaired growth and development of the brain and/or central nervous system.
  • Neonatal hyperbilirubinemia
    • Jaundice (yellowing of skin)
    • It occurs when an infant has a high amount of bilirubin in the blood
    • Newborn jaundice is most of the time is not harmful; however, a very high level of bilirubin in the blood can cause brain damage.

The above complications are not meant to scare or discourage you from starting a family. Rather, it is to remind you and your significant other the importance of preconception care. Prior to discontinuing contraception, it is important to meet with your health care provider to discuss your plans.

Your health care provider will likely obtain the following information at your initial preconception visit:

  • Medical and obstetrical history
    • Duration of diabetes
    • Acute and chronic complications
    • Current diabetes management (use of oral glucose-lowering agents and/or insulin regimen)
    • Other medications
    • Other medical conditions
  • Physical exam
    • Blood pressure
    • Eye exam by an ophthalmologist
    • Cardiovascular exam
    • Neurological exam
  • Lab evaluation
    • A1c test (average blood sugar over the past 3 months)
    • Serum creatinine and urinary excretion of total protein (tests for kidney function/damage)
    • Thyroid stimulating hormone (evaluates thyroid function)
  • Management plan
    • Selection of appropriate medication and/or insulin
      • Provide education on insulin injection if not previously provided
      • Insulin is usually preferred over oral diabetes medications as there is a lack of long-term safety data for many of the non-insulin agents.
    • Determine frequency of blood sugar monitoring
    • Set glycemic goals
      • Preconception A1c:
        • <7 % (if this can be achieved without frequent hypoglycemia)
      • Preconception blood sugar targets:
        • Before meals: 80-110 mg/dL
        • 2 hours after meals: <155 mg/dL
      • Follow up plan
        • Follow up may be needed as frequently as every 1-2 months until your diabetes is under optimal control at which point your physician may give you the go ahead to discontinue contraception and begin your journey to conception.

For many people making the decision to try and conceive is both private and personal. If you are comfortable please consider sharing your experiences and/or questions with the Type2Diabetes.com community: Type2Diabetes.com Forums.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Type2Diabetes.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
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