PRECONCEPTION CARE FOR WOMEN WITH DIABETES Care by an interdisciplinary diabetes healthcare (DHC) team

PRECONCEPTION CARE FOR WOMEN WITH DIABETES Care by an interdisciplinary diabetes healthcare (DHC) team prior to conception and during pregnancy has been shown to minimize maternal and fetal risks in women with diabetes mellitus (1-5). An early working relationship should be established between the woman and the DHC team (composed of diabetes nurse educators, registered dietitians, obstetricians and endocrinologists/internists) to optimize care and assess whether self-care practices and social supports will be adequate during pregnancy (2-4,6).When such care results in optimal glycemic control, the risks of spontaneous abortion, congenital malformations, pre-eclampsia and progression of retinopathy are reduced (1-11).The incidence of congenital anomalies (the most significant fetal complication) decreases as preconception glycemic control improves (5,8-10,12).Women with type 1 or type 2 diabetes should strive to optimize glycemic control (see “Targets for Glycemic Control,” p. S18, and Table 1) (7,8,13). While an increasing number of women with type 2 diabetes are being managed in pregnancy clinics, they are often referred postconception, still using oral antihyperglycemic agents and with poor metabolic control (14).Whenever possible, women with type 2 diabetes who are planning pregnancy should be referred to the DHC team. Oral antihyperglycemic agents should be discontinued, and an insulin regimen appropriate for pregnancy should be established. Women with poorly controlled diabetes have a 2to 3-fold increased risk of offspring with all congenital anomalies, including a 1% risk for neural tube defects (15). A folic acid supplement of 1 to 4 mg/day from preconception until 13 weeks’ gestation may reduce this risk (15,16).