What are the goals of prepregnancy management of women with preexisting diabetes?

Updated: Apr 29, 2020
  • Author: Thomas R Moore, MD; Chief Editor: George T Griffing, MD  more...
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Answer

Answer

The insulin regimen should result in a smooth glucose profile throughout the day, with no hypoglycemic reactions between meals or at night. Initiate the regimen early enough before pregnancy so that the glycohemoglobin level is lowered into the reference range for at least 3 months before conception.

Patients should take a prenatal vitamin containing at least 1.0 mg of folic acid daily for at least 3 months before conception to minimize the risk of neural tube defects in the fetus.

The development of family, financial, and personal resources necessary to achieve successful pregnancy is important. Pay particular attention to support systems that permit extended bedrest in the third trimester if necessary.

Preemptive outreach is helpful. In many perinatal centers, diabetes-in-pregnancy programs focus on outreach to nonpregnant reproductive-aged women with diabetes in order to minimize the morbidity attendant to poor periconceptional control. Urge nonpregnant women to avoid pregnancy until their HbA1C value is in within the reference range (< 6.5%).

Hone and Jovanovic have summarized a convenient and structured method of managing diet and insulin therapy to optimize glycemic control. These principles are outlined in the subsequent sections. [71]


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