Two to five per cent of pregnancies in the UK are complicated by pre-existing diabetes and the prevalence of diabetes is increasing.1 Women with diabetes have a higher risk of miscarriage, preterm labour, congenital anomalies, pre-eclampsia and macrosomia. Diabetic retinopathy can also deteriorate during pregnancy.
There is an increased risk of adverse outcomes in women who become pregnant during a period of poor glycaemic control. Improving glycaemic control before conception minimises the risk of complications associated with diabetes. Women with diabetes should be advised that unplanned pregnancy is best avoided. Diabetic woman should be counselled about contraceptive options from adolescence onwards.2
Aiming for a body mass index (BMI) below 27 prior to pregnancy may be beneficial.1 Women should be counselled on taking folic acid supplements (5mg per day), glycaemic control, possible medication changes, self-monitoring of blood glucose levels, recognising symptoms of hyper/hypoglycaemia, and renal and retinal assessments.
Oral hypoglycaemic agents should be stopped during pregnancy with the exception of metformin. Diabetics who are hypertensive should have angiotensin-converting enzyme inhibitors and angiotensin-II receptor antagonists stopped in favour of safer alternatives. Statin therapy should not continue during pregnancy.