Inm-1: Pre-Gestational Diabetes Mellitus (Pre-GDM)

Despite progress in diabetes care and treatment, pregnancies in women with either type 1 or, type 2 DM are still associated with poorer outcomes with respect to healthy non diabetic women. Pregestational DM complicates 0.2 - 0.6% of pregnancies, 35% had type1 and 66% had type 2 DM. In contrast to GDM, pre GDM is more serious because the potential effects of uncontrolled glycemic levels begins at fertilization and implantation, continue throughout pregnancy and remain as a postpartum threat during breast feeding. To prevent excess complications in mother and fetus, diabetic care and education must begin before conception. This is best accomplished by a multidisciplinary team that includes a diabetologist (internist), an obstetrician familiar with management of high risk pregnancy, diabetes educators including: Nurse, dietitian and social worker and other specialists as deemed necessary. Pregnant women with type 1 and type 2 diabetes should talk with a diabetes nutritionist, to determine their goals for daily calories, carbohydrates, nutritional balance in foods, and timing of eating throughout the day. The goals of preconception care are: involve and empower the patient in the management of her diabetes, achieve the lowest HbA1C test without excessive hypoglycemia, assure effective contraception until stable and acceptable glycemia is achieved and identify, evaluate and treat long-term diabetes complications such as retinopathy, nephropathy, neuropathy, hypertension and coronary disease.