Diabetes forces you to plan your conception

NEW YORK (HealthDay News)—Doctors should ask diabetic women about their childbearing intentions at every visit to ensure they receive appropriate care before conception occurs, according to new guidelines.

This measure will help prevent miscarriages and birth defects among women who have diabetes before pregnancy, the authors write in the Journal of Clinical Endocrinology & Metabolism.

“We developed these guidelines at a time when diabetes rates are rising among women of reproductive age, and very few women with diabetes receive adequate preconception care,” said lead author Dr. Jennifer Wyckoff, an endocrinologist at the University of Michigan in Ann Arbor.

“In addition to preconception planning, the guideline addresses advances in diabetes technology, timing of delivery, medications, and diet,” she said.

The joint guideline was issued by the Endocrine Society and the European Society of Endocrinology and published recently. Its suggestions include:

—Ask all diabetic women of childbearing age about their intention to conceive, and ask this question at every visit to the doctor, whether related to their reproductive, diabetic, or regular care.

—Schedule delivery before 39 weeks for pregnant women with diabetes, as the risks associated with continuing the pregnancy may outweigh those of early delivery.

—Discontinue use of GLP-1 weight-loss medications before pregnancy occurs.

—Avoid the use of metformin in pregnant women who are already using insulin.

—Use hybrid closed-loop insulin pumps with continuous glucose monitoring in pregnant women with type 1 diabetes.

—Participate in family planning and use contraception until the woman with diabetes is ready to become pregnant.

The team developed these recommendations based on evidence from randomized controlled trials, noted researcher Dr. Annunziata Lapolla, a diabetes specialist at the University of Padua, Italy.

"Given the rise in obesity-related type 2 diabetes worldwide and the number of women with this condition who become pregnant, these recommendations have also addressed issues related to proper nutrition and therapeutic approaches for these women," Lapolla added.

Other groups that signed the guidelines include the American Diabetes Association, the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, the International Association of Diabetes and Pregnancy Study Groups, the European Association for the Study of Diabetes, the Association of Diabetes Education and Care Specialists, and the American Pharmacists Association.