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Acute endocrine presentations in general practice

Type 2 diabetes: preparing for pregnancy

Vivienne Miller

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Abstract

Penny is a 38-year-old Caucasian woman with type 2 diabetes diagnosed six months ago. She has recently married a man with older children and is considering becoming pregnant for the first time. Her body mass index (BMI) is stable at 31 kg/m2 (class 1 obesity range), and her HbA1c level is 6.9% (52mmol/L) while taking metformin extended release 1 g at night. She has well-controlled hypertension for which she takes combined perindopril and indapamide daily. She has had a low level of microalbuminuria and the urinary albumin to creatinine ratio is 4.5 mg/mmol. Given Penny’s medical conditions, she wants to know what the risks are to her and for the baby if she became pregnant, and how she can best prepare for a pregnancy. She stopped taking the oral contraceptive pill about two months ago and has just experienced her first natural period. She has booked a prolonged appointment with you to discuss her concerns.

Key Points

  • Pregnancies need to be planned in patients with diabetes; any associated medical conditions or complications need to be appropriately managed before and during the pregnancy.
  • Patients with diabetes are at increased risk of a variety of complications during pregnancy and delivery, including infertility, an increased risk of congenital abnormalities, miscarriage and stillbirth, infections, intrauterine growth retardation, polyhydramnios, placental abruption and insufficiency, macrosomia, shoulder dystocia and neonatal hypoglycaemia.
  • Referral of women with diabetes to an endocrinologist is required prior to conception as strict control of blood glucose levels before and into early pregnancy reduces risk of congenital abnormalities and fetal loss. Specialised diabetes and obstetric care is needed throughout pregnancy.
  • Patients with diabetes require a formal eye assessment before and during pregnancy to ensure they do not develop or experience worsening retinopathy.

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