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Diabetes mellitus
Diabetes mellitus and pregnancy
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- Women with Diabetes mellitus are usually fertile and can get pregnant.
While Progesterone only contraception is usually recommended, all forms of
contraception (including COC) are safer than pregnancy
- Diabetes can be harmful to the developing foetus, particularly at
conception and during the first 8 weeks of pregnancy. Improving blood sugars
(BM 4-6 pre food, HbAlc <6.5% prior to conception) can reduce the risk of
major foetal abnormalities from 12x that of the general population to 2x the
usual non-diabetic rates
- Insulin requirements increase during pregnancy. Ketoacidosis may develop
with even mild hyperglycaemia, and almost always results in foetal demise
Key targets
- BM 4-6 pre food
- HbAlc <6.5% prior to conception
- High dose folic acid (5mg daily) prescribed pre-conceptually and for the
first 12 weeks of pregnancy
- Eye changes can deteriorate and dilated fundoscopy should be performed
during each trimester
- Review drugs and stop ACE Inhibitors pre-pregnancy
Women with diabetes should be
- Aware of the benefits of planning pregnancy
- Aware of the risks of conceiving with suboptimal control
- Encouraged to use a reliable form of contraception until HbAlc <
6.5%
- Referred urgently to the local diabetes specialist team if they are
already pregnant or planning a pregnancy
(People on oral agents should be transferred to insulin prior to conception)
Source: Northumbria NHS Health Care Trust diabetes protocol