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Chronic Medical Conditions: Diabetes

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Here are some specific counseling points on the importance of disease maintenance and potential reproductive consequences of poorly controlled diabetes:

 

  1. Achieving / Maintaining Optimal Weight

  • The relationship between diabetes and obesity is well-understood by the medical community. However, the importance of a healthy weight needs to be re-emphasized for the patient.

    1. Optimal Glycemic Control

  • An HbA1C <1% above normal (a normal value is < 7%) is associated with a rate of spontaneous abortion and congenital malformation equal to that observed in the general population.

  • Therefore, the goal for the preconception period and first trimester is to achieve the lowest HbA1C possible that does not put the pregnant woman at hypoglycemic risk.

  • 6-7% HbA1C or as near normal as possible is optimal

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  • How to achieve this goal: Self-Monitoring

  • The ADA recommends setting goals for self-monitored glucose:

  •  Preprandial = 80-100 mg/dl

  • 2 h Postprandial = <155 mg/dl

  • Patients may opt initially not to check their postprandial glucose levels. However, if low-risk HbA1C is not achieved (should be monitored at 1 or 2 month intervals), consider adding that step in addition to modifying her medication.

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