Preconception care for women with diabetes and prevention of major congenital malformations

Abstract

This article provides an overview of the rationale for diabetes preconception care interventions for women with diabetes and the efficacy in reducing the excess occurrence of major congenital malformations. The problems with broad use of individualized preconception care are considered. In addition, suggestions are made for the implementation of more comprehensive interventions in the community and usual diabetes care settings, to address the multiple ongoing challenges in the prevention of structural anomalies associated with preexisting diabetes. Based on the published evidence, successful preconception care can be considered to include: achievement of individualized target standardized glycosylated hemoglobin levels, adequate nutrition, and minimizing hypoglycemia before and after discontinuing effective contraception and during the transition to early prenatal care.

Epigenetic mechanisms underlying maternal diabetes-associated risk of congenital heart disease

“…While no study has directly linked levels of maternal HG in the first trimester when the heart develops with the risk of CHD, lower maternal glycosylated hemoglobin levels (hemoglobin A 1c ), which serve as an indicator of HG over the preceding 2-3 months, have been shown to be associated with a reduced risk of birth malformations in humans (70)(71)(72). It was recently reported that diabetes-induced elevation of maternal blood glucose levels during the 15th-18th week of gestation were correlated with CHD in a California-based case-control study (73).…”

Pregestational Diabetes Mellitus and Congenital Heart Defects

“…[17][18][19][20][21] The associations observed between maternal pregestational diabetes mellitus and CHDs are strong (ie, relative risk estimates of ≥4) and evident for type 1 and type 2 diabetes mellitus. 18,20,[22][23][24] Furthermore, the risks of CHDs and other birth defects are known to increase among the offspring of women with diabetes mellitus who have poorer metabolic control 25 and to be attenuated among the offspring of women with pregestational diabetes mellitus who are enrolled in preconception care programs focused on management of pregestational diabetes mellitus. 26,27 Although the underlying mechanisms for the association of diabetes mellitus with CHDs and other birth defects remain unclear, [28][29][30] it is evident that hyperglycemia plays an important role in the development of diabetes mellitus-associated adverse pregnancy outcomes.…”

Primary Prevention of Congenital Anomalies: Recommendable, Feasible and Achievable

“…Pregnant women with either type 1 diabetes or with T2D essentially show the same risk of CA because maternal hyperglycemia is the key teratogenic factor [30]. However, T2D represents the highest public health concern; its incidence is rising globally, calling for primary prevention strategies based on awareness raising and lifestyle modifications also in emerging economies [31].…”