TY - CHAP M1 - Book, Section TI - Diabetes 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. Y1 - 2015 N1 - T2 - Maternal Medicine 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. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - obgyn.mhmedical.com/content.aspx?aid=1115519705 ER -