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Chronic Medical Conditions: Diabetes

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For your diabetic patient who does want to attempt pregnancy, an important part of preconception visits with diabetic patients is establishing a baseline for end-organ damage, especially in areas that affect or are affected by pregnancy.

  • BP:  look specifically for orthostatic changes

  • Retinopathy:  should be done by someone expert in detecting diabetic eye disease

  • Cardiovascular exam:  making sure to rule out coronary artery disease and insure that they can handle the increased burden on the heart during pregnancy

  • Neurologic exam: looking specific for autonomic neuropathy (e.g., gastroparesis)

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    Lab Data Important in Establishing a Pre-pregnancy Baseline

  • HbA1C

  • After cessation of ACE inhibitors and ARBs, assess

  • Serum creatinine

  • Urinary excretion of protein

  • Williams Obstetrics defines significant proteinuria by the following parameters:1

  • 24 hour urine collection, abnormal: >300 mg, OR
  • persistent 30 mg/dL (1+ dipstick) in spot urine samples
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  • Additionally, the ADA cautions that patients with:

  • protein >190 mg/24h are at increased risk for hypertensive disorders during pregnancy

  • protein >400 mg/24h are at increased risk of IUGR late in pregnancy

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  • Counsel patients appropriately about these risks.

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  • TSH and free T4 in women with Type I DM (because 5-10% of them have hyper / hypothyroidism)

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    1. Cunningham FG, Leveno KL, Bloom SL, Hauth JC, Gilstrap LC III, Wenstrom KD. Williams obstetrics [Internet]. 22nd ed. New York (NY): McGraw-Hill; c2005 [cited 2009 Jul 20].1600 p. Available from http://www.accessmedicine.com (Access available with membership)