RT Book, Section
A1 Carson, Michael P.
A1 Newstead-Angel, Jill
A1 Saade, George R.
A1 Pacheco, Luis D.
A2 Pacheco, Luis D.
A2 Saade, George R.
A2 Hankins, Gary D.V.
SR Print(0)
ID 1115519705
T1 Diabetes
T2 Maternal Medicine
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071824163
LK obgyn.mhmedical.com/content.aspx?aid=1115519705
RD 2024/04/20
AB The  hallmark  of  management  for  women  with  diabetes  mellitus  (DM)  Type  1  or  2  is  pre-pregnancy  planning  to  educate/reinforce  the  concepts  of  a  proper  diet,  understand  the  risks  of  uncontrolled  diabetes  before  and  during  pregnancy,  and  optimize  insulin  management  to  achieve  proper  glycemic  control  starting  as  early  as  possible.  The  initial  study  correlating  an  elevated  maternal  HbA1c  at  the  time  of  conception  with  major  congenital  fetal  malformations  found  that  the  risk  is  approximately  doubled  when  the  value  is  >7%  and  increased  four  to  five  times  when  the  value  is  ≥8.6%.1  Subsequent  studies  have  found  that  the  relative  risk  goes  up  when  the  HbA1c  is  ≥6.6%,  and  a  systematic  review  noted  that  pre-pregnancy  care  can  reduce  the  HbA1c  by  1.9%.2,3  Clinicians  should  recognize  maternal  and  obstetric  issues  that  identify  women  at  risk  of  future  complications  that  require  immediate  forethought  and  planning  on  the  part  of  the  caregivers,  and  therefore,  “interpregnancy  care”  begins  immediately  following  delivery.