Pre-conceptional Counselling in Diabetes
Diabetes in pregnancy is associated with risks to the woman and to the developing fetus. Miscarriage, pre-eclampsia and preterm labour are more common in women with pre-existing diabetes. Congenital malformations, stillbirths, birth injury and perinatal mortality are also higher in children born to women with pre-existing DM compared to gestational DM. Additionally diabetic retinopathy can worsen rapidly during pregnancy.
As fertility specialist we have special opportunity to counsel these women in pre-conceptional period about all these implications and the need for optimal glucose control. As per NICE 2015 recommendations, it is required to maintain fasting plasma glucose in the range of 5-7mMol/L and HbA1c levels below 6.5%. This can be achieved by dietary advice & exercise plan pre-pregnancy. Oral glucose lowering drugs (except for Metformin) need to stopped and changed to insulin as they are not safe in pregnancy. If woman is taking any additional drugs like anti-hypertensives their safety has to be checked. These women should be screened for end-organ damage like retinopathy and nephropathy and counselled in detail about the importance of good diabetic control for the optimal maternal and neonatal outcome.
They need to be informed about delaying pregnancy till good diabetic control is achieved as increased glucose levels in peri-conceptional period are associated with increased risk of fetal congenital malformations and miscarriage. The women with diabetes are at increased risk of neural tube defects, so in the peri-conceptional period they should start taking 5 mg of Folic acid tablet daily when planning for pregnancy. These women will need more number of antenatal visits and more monitoring during pregnancy- all this has to be emphasized in pre-conceptional counselling. Poor glucose control in early pregnancy not only increases risk of malformations and miscarriage but also leads to long term health impacts on the child like increased risk of diabetes, obesity and cardiovascular diseases in adulthood. It has been seen that the children born to mothers with poor glucose control are more pre-disposed to these adulthood diseases later in their life (Fetal origin of adult disease). Women with diabetes should be the active member of team involved in their care so that she understands the importance of glucose monitoring and control. A good counselling in pre-conceptional period can go a long way in creating healthy mother, healthy child and healthy adults!!
|Written By:||Dr. Harpreet Kaur
MD, DNB (Gynae), FNB (Rep. Med.)Clinical Director,
Milann Fertility Center, Chandigarh
|Date:||November 14, 2016|