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Preconceptional Care of Women with Diabetes: The 10 Step Approach

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Dr Jubbin Jagan Jacob, Ludhiana    01 February 2018

  1. till HbA1c targets are met.
  2. Dietician consultation with individualized diet plan, educate about weight loss (if BMI >27). Advice on smoking and alcohol cessation. CHO counting (if not aware).
  3. Regular exercise and avoidance of hypoglycemia.
  4. Optimize glycemic control: In type 1 diabetes: MSII/CSII (intensive insulin regimes); consider twice-daily basal insulin; matched prandial insulin dosing; rapid-acting analogs to be considered. In type 2 diabetes: Stop all oral agents except metformin; initiate insulin if required.
  5. Monthly HbA1c. In addition, SMBG at home at least 4-6 times daily. Overnight capillary glucose on occasion. Ketone testing for type 1 diabetes patients.
  6. Measure BP at each visit. Target BP systolic <130 mmHg and diastolic <90 mmHg. Stop ACEIs and ARBs when contraception is discontinued. Use alternative agents e.g., methyldopa.
  7. Stop statin at discontinuation of contraception. Screen for hypertriglyceridemia.
  8. Screen for complications. Dilated fundus examination or retinal imaging; treat significant retinopathy prior to discontinuation of contraception. Assess degree of proteinuria and baseline renal functions. If significant overt proteinuria or eGFR <60 ml/min/1.73 m2 present, then refer to a kidney specialist. Cardiac screening only if >35 years old or symptomatic.
  9. Screen for rubella autoimmunity.
  10. Start on folic acid supplementation.

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