2.0.0.0 PRE­CON­CEP­TION COUN­SEL­ING

2.1.0.0 Rec­om­men­da­tions

Rec­om­men­da­tions

14.1 Start­ing at pu­ber­ty and con­tin­u­ing in all women with re­pro­duc­tive po­ten­tial, pre­con­cep­tion coun­sel­ing should be in­cor­po­rat­ed into rou­tine di­a­betes care. A

14.2 Fam­i­ly plan­ning should be dis­cussed and ef­fec­tive con­tra­cep­tion should be pre­scribed and used until a woman is pre­pared and ready to be­come preg­nant. A

14.3 Pre­con­cep­tion coun­sel­ing should ad­dress the im­por­tance of glycemic man­age­ment as close to nor­mal as is safe­ly pos­si­ble, ide­al­ly A1C <6.5% (48 mmol/‍mol), to re­duce the risk of con­gen­i­tal anoma­lies, preeclamp­sia, macro­so­mia, and other com­pli­ca­tions. B

All women of child­bear­ing age with di­a­betes should be coun­seled about the im­por­tance of tight glycemic con­trol prior to con­cep­tion. Ob­ser­va­tion­al stud­ies show an in­creased risk of di­a­bet­ic em­bry­opa­thy, es­pe­cial­ly anen­cephaly, mi­cro­cephaly, con­gen­i­tal heart dis­ease, and cau­dal re­gres­sion, di­rect­ly pro­por­tion­al to el­e­va­tions in A1C dur­ing the first 10 weeks of preg­nan­cy (3). Al­though ob­ser­va­tion­al stud­ies are con­found­ed by the as­so­ci­a­tion be­tween el­e­vat­ed pericon­cep­tional A1C and other poor self-‍care be­hav­iors, the quan­ti­ty and con­sis­ten­cy of data are con­vinc­ing and sup­port the rec­om­men­da­tion to op­ti­mize glycemic con­trol prior to con­cep­tion, with A1C <6.5% (48 mmol/‍mol) as­so­ci­at­ed with the low­est risk of con­gen­i­tal anoma­lies (3-6).

There are op­por­tu­ni­ties to ed­u­cate all women and ado­les­cents of re­pro­duc­tive age with di­a­betes about the risks of un­planned preg­nan­cies and im­proved ma­ter­nal and fetal out­comes with preg­nan­cy plan­ning (7). Ef­fec­tive pre­con­cep­tion coun­sel­ing could avert sub­stan­tial health and as­so­ci­at­ed cost bur­dens in off­spring (8). Fam­i­ly plan­ning should be dis­cussed, and ef­fec­tive con­tra­cep­tion should be pre­scribed and used until a woman is pre­pared and ready to be­come preg­nant.

To min­i­mize the oc­cur­rence of com­pli­ca­tions, be­gin­ning at the onset of pu­ber­ty or at di­ag­no­sis, all girls and women with di­a­betes of child­bear­ing po­ten­tial should re­ceive ed­u­ca­tion about 1) the risks of mal­for­ma­tions as­so­ci­at­ed with un­planned preg­nan­cies and poor metabol­ic con­trol and 2) the use of ef­fec­tive con­tra­cep­tion at all times when pre­vent­ing a preg­nan­cy. Pre­con­cep­tion coun­sel­ing using de­vel­op­men­tal­ly ap­pro­pri­ate ed­u­ca­tion­al tools en­ables ado­les­cent girls to make well-‍in­formed de­ci­sions (7). Pre­con­cep­tion coun­sel­ing re­sources tai­lored for ado­les­cents are avail­able at no cost through the Amer­i­can Di­a­betes As­so­ci­a­tion (ADA) (9).