Diabetes Mellitus Preconception Counseling

Aka: Diabetes Mellitus Preconception Counseling

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II. Contraindications: Pregnancy

  1. Renal disease
  2. Uncontrolled Hypertension
  3. Ischemic Heart Disease (Coronary Artery Disease)

III. Labs: Preconception Evaluation

  1. Glycosylated Hemoglobin (Hemoglobin A1C)
  2. Lipid profile
  3. Urine 24 hour collection
    1. 24 Hour Urine Protein
    2. Creatinine Clearance
  4. Ophthalmologic examination
  5. Electrocardiogram
    1. Indicated for Diabetes Mellitus more than 10 years

IV. Management: Preconception Blood Sugar Goals

  1. Glycosylated Hemoglobin (Hemoglobin A1C): <8.0%
  2. Blood Sugar
    1. Fasting Blood Sugar: 60-100 mg/dl
    2. Two hour Postprandial Blood Sugar: 100-120 mg/dl

V. Complications: Fetal

  1. Congenital Malformations: 6-10% Incidence
  2. Organs that develop in first 7-8 weeks gestation
    1. Ventricular Septal Defect
    2. Neural Tube Defect (e.g. Spina bifida or Anencephaly)
    3. Caudal regression syndrome
  3. Fetal Macrosomia
  4. Fetal Relative Risk of developing Diabetes Mellitus: 3

VI. Complications: Maternal

  1. Pregnancy Induced Hypertension (PIH)
  2. Complicated Urinary Tract Infection

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