SAN FRANCISCO — The first step in preparing a diabetic woman for pregnancy is noticing that she has diabetes before she conceives.
Women with type 2 diabetes often don't get diagnosed until pregnancy, by which time it's too late to reduce the risk of congenital anomalies through better glycemic control, Dr. Ingrid Block said at a meeting on diabetes and endocrinology sponsored by the University of California, San Francisco.
Congenital anomalies in infants of diabetic mothers occur as early as 5 weeks after the last menstrual period (for caudal regression) and as late as 8 weeks after the last period (for cardiac anomalies).
“If you don't sit down with that patient and ensure that she plans her pregnancy and that she has good glycemic control before conception, you run the risk that she'll find out she's 8 weeks pregnant and she has missed the opportunity” to avoid these congenital anomalies, said Dr. Block, of the university.
With any new female patients, pay attention to their obstetric histories, she urged. If a nondiabetic woman has delivered a large baby or had gestational diabetes, she's at increased risk for developing type 2 diabetes and should be screened for it periodically.
Congenital anomalies occur in 6%–10% of pregnancies among diabetic women with uncontrolled hyperglycemia, compared with an incidence of 2% in nondiabetic women. Emphasize effective contraception until diabetes patients achieve stable glycemia, Dr. Block said.
Preconception counseling and care should help women optimize glycemic control before pregnancy, which significantly reduces the risks of anomalies and fetal death, studies have shown. Women with type 2 diabetes should transition before conception from managing their diabetes using diet alone or oral therapies to using insulin, she added.
Identification and treatment of long-term complications of diabetes will give physicians an opportunity to warn some patients about difficult or nonviable pregnancies.