Preconception care of women with diabetes: a review of current guideline recommendations

Abstract

BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) continues to rise worldwide. More women from developing countries who are in the reproductive age group have diabetes resulting in more pregnancies complicated by T2DM, and placing both mother and foetus at higher risk. Management of these risks is best achieved through comprehensive preconception care and glycaemic control, both prior to, and during pregnancy. The aim of this review was to compare the quality and content of current guidelines concerned with the preconception care of women with diabetes and to develop a summary of recommendations to assist in the management of diabetic women contemplating pregnancy.MethodsRelevant clinical guidelines were identified through a search of several databases (MEDLINE, SCOPUS and The Cochrane Library) and relevant websites. Five guidelines were identified. Each guideline was assessed for quality using the AGREE instrument. Guideline recommendations were extracted, compared and contrasted.ResultsAll guidelines were assessed as being of high quality and strongly recommended for use in practice. All were consistent in counselling about the risk of congenital malformation related to uncontrolled blood sugar preconceptionally, ensuring adequate contraception until glycaemic control is achieved, use of HBA1C to monitor metabolic control, when to commence insulin and switching from ACE inhibitors to other antihypertensives. Major differences were in the targets recommended for optimal metabolic control and opinion regarding the usage of metformin as an adjunct or alternative treatment before or during pregnancy.ConclusionsInternational guidelines for the care of women with diabetes who are contemplating pregnancy are consistent in their recommendations; however some are more comprehensive than others. Having established current standards for the preconception care of diabetic women, there is now a need to focus on guideline implementation through an examination of the barriers and enablers to successful implementation, and the applicability of the recommendations in the local setting.

Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice

“…Despite this, many did not actually recommend using contraception or delaying pregnancy until optimal control was achieved. Diabetes preconception guidelines internationally are consistent in counselling about ensuring adequate contraception until glycaemic control is achieved, but differences in recommended preconception HbA1c targets may contribute to clinical uncertainty [37]. Contributors to a lack of counselling for delaying pregnancy in this circumstance may be the complexity of care and cross-cultural communication difficulties as well as health providers not wishing to be overly negative or authoritarian.…”

5 Numbers Women with Diabetes Should Know Before Pregnancy

“…Severe birth defects occur when blood glucose is and has been high. Therefore, a hemoglobin A1C greater than 10% is considered a contraindication to pregnancy [3], meaning that pregnancy is not recommended because the risk of birth defects is too high.…”

“…However, glyburide and metformin have been promising in clinical studies and are often used, especially in women who were using these medications prior to pregnancy. Since the safety profiles of other medications are not well known, it is important to modify medication regimens prior to pregnancy to allow for both good control of blood sugar and safety to the developing fetus [3].…”

Pregnancy and Diabetes Management: Advances and Controversies

“…Optimizing maternal and fetal outcomes is best done with preconception planning for all types of diabetes in pregnancy. In pregestational diabetes, women who know they have T1DM or T2DM should achieve and sustain glycemic control before conception to minimize their risk of fetal malformation (2)(3)(4)(5). Organogenesis is essentially completed by 7 weeks gestation, often before the woman knows she is pregnant.…”

“…2 Pregestational diabetes includes both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).…”