By Donald R. Coustan, Abbot R. Laptook, Carol J. Homko, Susan Biastre, Julie M. Daley
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Extra resources for Medical Management of Pregnancy Complicated by Diabetes
If she has T1D and is ≥25 years old, the chance of her child developing T1D at some point is ~1%; if she is <25 years old, this chance increases to ~4% (Warram 1991). If both parents have T1D, the risk is higher, in the range of 10–25% (Warram 1991). S. htm). 6%) when the onset was later (American Diabetes Association 2012a). Although these risks of developing diabetes are higher than that of the general population, they are not significant enough to advise a woman against pregnancy on genetic grounds.
Clearly identify for the woman and her partner the risks of congenital anomalies and spontaneous abortions and their relation to glucose control. � Provide realistic information about chronic complications of type 1 diabetes (T1D) and type 2 diabetes (T2D), their potential impact on pregnancy and childbearing, and the effect of pregnancy on chronic complications. � Assess the woman’s fitness for pregnancy, paying special attention to retinopathy, nephropathy, hypertension, neuropathy, and ischemic heart disease.
A planned pregnancy is a major objective of preconception counseling; thus, establishing an effective contraceptive method must be an early priority in prepregnancy planning (see also chapter 2). The health-care provider should review with the woman her options for contraception and help her choose the one most appropriate for her situation. 1) (see also chapter 10). This prepregnancy counseling session is the ideal moment to emphasize to the woman her two- to fivefold increased risk of having a baby with a congenital anomaly and her increased risk for having a first-trimester SAB if blood glucose levels are not well controlled.