Preconception Care for Individuals with Diabetes

Abstract

The incidence of diabetes has been increasing and, in parallel, so has the incidence of females in their childbearing years with diabetes. Preconception care is important in females with diabetes due many factors related to fertility, blood glucose control, and complications. For example, many individuals with Type 2 diabetes are obese, which can affect contraceptive efficacy, fertility, and fetal growth. Additionally, patients with all types of diabetes are at risk for disordered eating, which can be harmful to a developing fetus. Both hypoglycaemia and hyperglycaemia are known to increase the risk of adverse maternal and neonatal outcomes, including during the first trimester, when many females are not aware of pregnancy. Additionally, individuals with diabetes are at risk for complications, such as atherosclerotic cardiovascular disease, nephropathy, retinopathy, and neuropathy, that can lead to complicated pregnancies. Importantly, several of the medications used to control blood glucose, and manage diabetes complications, are not recommended for use during pregnancy due to potential fetal harm. For these reasons, females with diabetes in their childbearing years are encouraged to utilise reliable contraception, so that pregnancies can be planned, or should be treated with medications with low teratogenicity potential. Thus, the preconception care of females with diabetes is complex, and the increasing prevalence of this patient population warrants greater awareness among clinicians. This narrative review summarises the current standard of preconception care for individuals with diabetes, including the management of contraception, weight, blood glucose, hypertension, and dyslipidaemia.