The Importance of Pre-Conception Planning for Women with Diabetes
The majority of women with diabetes don't seek pre-conception counseling. Many don't know that diabetes can contribute to complications during pregnancy and greatly increases the risk of birth defects for babies, and that preconception planning dramatically reduces these risks. Some women don't tell their health care providers when they are planning pregnancies, and others don't realize they require special care before they become pregnant.
Pre-conception care is especially important because babies born to women with diabetes, especially those with high blood sugars, have a much greater risk of birth defects. The most common congenital defects for babies born to diabetic women are heart defects, and a fetus' heart is usually already formed by the time a woman discovers she is pregnant.
Jennifer Wyckoff, M.D., Assistant Professor of Internal Medicine, and Medical Director, Adult Diabetes Education Program who started the most recent version of the U-M Pre-conception Diabetes Care Clinic, says research shows that good glycemic control before conception reduces the risk of birth defects for pregnant women with pre-existing diabetes.
Dr. Wyckoff says a diabetic woman should talk to whoever is providing her medical care and find out if that person is comfortable providing pre-conception care. She says, "Communication is incredibly important." Knowing that a woman is planning to become pregnant, helps her doctor to consider a whole other set of factors. The blood sugar goals for a healthy diabetic and a healthy diabetic planning a pregnancy are different.
When seeking a pre-conception counseling program, Wyckoff recommends that women should find a team that includes an endocrinologist, a maternal/fetal medicine or high risk Obstetrics specialist, and a nutritionist. U-M's team includes all of these. The U-M maternal/fetal medicine specialist for women with diabetes is Mark Chames, M.D., who leads the prenatal diabetes clinic.
Pre-conception counseling also helps educate women with diabetes about other aspects of their health that will be impacted by pregnancy. Before conception, diabetic women may want to visit their eye doctors for an eye exam, because pregnancy can exacerbate diabetic eye disease. Women with diabetes also need to be checked for kidney function before becoming pregnant. Dr. Wyckoff says that having management plans in place before pregnancy for diabetes and its complications helps to avoid problems during pregnancy.
Planning is also important for women to understand what medications they should and should not take during pregnancy. Dr. Wyckoff says that some women continue to take unsafe medications (like ACE inhibitors and statins) during pregnancies. Other women make the mistake of discontinuing all medications when they realize they are pregnant, and that is dangerous too. For instance, stopping medications that control high blood sugar still puts the baby at risk.
The U-M Pre-Conception Diabetes Care Clinic suggests that diabetic women start pre-conception care six months before they start trying to get pregnant. Once a woman with diabetes discovers she is pregnant, she should then be scheduled for her first appointment in the pregnancy/diabetes clinic within a week. "The goal is absolutely to have a safe, healthy, normal, vaginal delivery," says Dr. Wyckoff. Pre-conception care is a major step in achieving that goal.
For more information or to schedule an appointment call: 734-647-5871 or (toll-free) 866-266-5221.
If you are diabetic and pregnant call 734-763-6295 to schedule an appointment in the U-M Diabetes and Pregnancy Clinic.
Upcoming Events:
Jennifer Wyckoff is one of the speakers at the Michigan Comprehensive Diabetes Center World Diabetes Day. Wyckoff's topic is "Diabetes Headlines: What Are People Talking About?"
