Preconception Care for Women Living with Diabetes

Brandee Newsom, APRN, BC-ADM, CDE, works in Perinatal Diabetes Management at the High Risk Pregnancy Center in Las Vegas, NV. She recently presented on gestational diabetes at our 2019 Annual Conference. She shares the below for World Diabetes Day.

Today is World Diabetes Day, and as practitioners who care for women, it’s critical that we understand how this condition impacts our patients -especially when it comes to pregnancy. Diabetes can be managed before and during pregnancy to mitigate the risks to our pregnant patients and improve their long-term health. I offer this overview of screening and diagnosis, risk reduction, and the latest developments so we can provide quality care to our patients with diabetes and those at risk for diabetes.

By the Numbers

People living with diabetes are 2-4 times more likely to develop and die from heart disease or stroke. These risks are greater in women than men. Women with diabetes who become pregnant have a 10-20% chance of developing preeclampsia in addition to other adverse outcomes.

Screening and Diagnosis

If a woman is at risk for diabetes, she should be screened and counseled regarding risks. This includes women with the following risk factors:

  • Overweight/obese
  • Family history of diabetes
  • High blood pressure
  • High cholesterol
  • PCOS
  • Ethnicities including Native American, Asian, African American, Hispanic, or Pacific Islander
  • History of gestational diabetes or macrosomic fetus
  • History of cardiovascular disease

Criteria for the diagnosis of diabetes:

  • Fasting plasma glucose ≥126 mg/dL (fasting is defined as no caloric intake for at least 8 hours)*
  • 2-h PG ≥200 mg/dL during 75-gram glucose tolerance test*
  • A1C ≥ 6.5%*
  • Random plasma glucose ≥200 mg/dL, with classic symptoms of hyperglycemia or hyperglycemic crisis

(* In the absence of unequivocal hyperglycemia, diagnosis requires two abnormal test results from the same sample or in two separate test samples.)

Any woman with diabetes should be counseled if they are planning a pregnancy within the year. Referring to an MFM specialist for a prepregnancy consultation can be helpful in this regard especially if the patient has additional risk factors.

Reducing Risk for Mother and Baby

In optimizing the health of the mom, fetus and neonate, the two key modifiable risk factors are BMI and blood sugar levels. In this regard:

  • Prior to pregnancy their A1C should be less than 6.0%, their fasting blood sugar should be <95 and 2 hours after meals should be < 120.
  • For optimal risk reduction, they should try and achieve a normal BMI prior to conception.
  • Excellent nutrition and a moderate amount of exercise are imperative for improving health, especially for women with diabetes planning a pregnancy. Referrals to a certified diabetes educator (CDE), a Registered Dietitian (RD/RDN), or a Diabetes Program that is recognized by the ADA/AADE can help.
  • They should have screening for any diabetes related complications such as heart disease, hypertension, or thyroid disease.
  • They should be up to date on their eye and dental exams as well as their vaccinations.
  • Since these patients have an increased risk of neural tube defects, they should be taking folic acid at least 3 months prior to conception and through the first trimester.

New Developments

The link between diabetes and cardiovascular disease has been well established. Even gestational diabetes and future risk of cardiovascular disease has been well studied. Interestingly, a retrospective study published in the Lancet in March 2019 shows that the risk of cardiovascular disease extends into the non-diagnostic range for glucola results. It showed that for each 1 mmol/L increment in the glucose challenge test result was associated with a 13% higher risk of cardiovascular disease after adjustment for age, ethnicity, income, and rurality. This relationship persisted after excluding women with gestational diabetes.

Helpful Resources

ACOG committee opinion on Prepregnancy Counseling

ACOG FAQ handout for patients Healthy Pregnancy for Women with Diabetes

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