Preconception Care of Women With Diabetes AMERICAN DIABETES ASSOCIATION DIABETES AND CONGENITAL MALFORMATIONS

DIABETES AND CONGENITAL MALFORMATIONS — Major congenital malformations remain the leading cause of mortality and serious morbidity in infants of mothers with type 1 or type 2 diabetes. Several studies have established an association between elevated maternal glucose or glycohemoglobin levels during embryogenesis and high rates of spontaneous abortions and major malformations in newborns. Clinical trials of preconception care to achieve stringent blood glucose control in the preconception period and during the first trimester of pregnancy have demonstrated striking reductions in rates of malformations compared with infants of diabetic women who did not participate in preconception care. (For further discussion, see the American Diabetes Association technical review on this subject [1].) Unfortunately, unplanned pregnancies occur in about two-thirds of women with diabetes, precluding adequate preconception care and leading to a persistent excess of malformations in their infants. To minimize the occurrence of these devastating malformations, standard care for all women with diabetes who have child-bearing potential should include 1) counseling about the risk of malformations associated with unplanned pregnancies and poor metabolic control and 2) use of effective contraception at all times unless the patient is in good metabolic control and actively trying to conceive.