Diabetes and Pregnancy
Health Care Professionals working in the primary care setting are ideally placed to raise the issue of pregnancy planning with women of childbearing age who have a diagnosis of diabetes or a history of Gestational Diabetes Mellitus (GDM). These women need counselling to either plan a pregnancy or avoid a pregnancy with reliable, appropriate contraception. If planning a pregnancy, contraception is important until adequate glycaemic control along with blood pressure and lipid control are achieved. Medications need to be reviewed to ensure they are not teratogenic and folic acid 5mg O. D. needs to be prescribed to prevent against neural tube defects.
Screening for complications of diabetes is required and stabilisation of pre-existing complications is necessary before conception.
Routine pre-pregnancy care is also required e.g. establishing rubella vaccination status, avoidance of alcohol and cigarette smoking, etc.It is important to refer all expectant women to a consultant endocrinologist immediately.
In 2010, the HSE developed Guidelines for the Management of Pre-gestational and Gestational Diabetes Mellitus from Pre-conception to the Postnatal period. These include guidance for women with Type 1 and Type 2 diabetes from pre-conception to the postpartum period and also for women who develop GDM. Guidance is also provided in A Practical Guide to Integrated Type 2 Diabetes Care (ICGP, 2016) pages 24-27.