Preconception counseling

Preconception counseling is important for all women in child-bearing age, yet more for those who are diagnosed with DM.  

Women with diabetes who receive preconception counseling have better preconception glycemic control and are more likely to have favorable pregnancy outcomes, including lower rates of congenital anomalies and spontaneous abortions. By the time that a woman knows she is pregnant, much fetal organogenesis has typically been completed.

Counseling can optimally be provided by a multidisciplinary team that includes the diabetes specialist, diabetes educator, dietician, obstetrician and other health care providers, as indicated. Woman's partner can also be included.

Topics that need to be discussed during preconception counseling are:

• The need for a pregnancy to be planned and to occur only when the woman has
  • sufficient glycemic control,
  • appropriate assessment and management of comorbidities, such as retinopathy and hypertension
  • discontinued pontentially unsafe -during pregnancy- medications and 
  • has been taking the appropriate folic acid supplement
• The importance of smoking cessation
• The importance of cooperation with the team (both before and during pregnancy)
• The great personal effort that is required and
• The importance of notifying the health care team without delay in the event of conception.

 Based on the arguments mentioned above:

R 1.1 Recommend preconception counseling be provided to all women with DM, who consider pregnancy. (1++)