Women with pre-existing diabetes are at increased risk of a number of adverse pregnancy outcomes, including major foetal malformation, stillbirth and pre-eclampsia. Poor glucose control in the preconception period and early pregnancy has been linked to an increased risk of adverse outcomes. South Western Sydney has much higher rates of malformations among women with pre-existing diabetes than elsewhere.
From adolescence, it is recommended that all women with diabetes, regardless of pregnancy intention, receive preconception counselling. This is a discussion between women and their healthcare professionals about the importance of planning for pregnancy and should inform women of the need for pre-pregnancy care prior to conception. Pre-pregnancy care is specialist care delivered by the multidisciplinary diabetes care team to help ensure a woman is prepared for pregnancy, and includes optimization of glycaemic control, the prescription of high dose folic acid supplements (5 mg) and review of their current medications.
Women with pre-existing diabetes are considered high-risk and should be managed in a multi-disciplinary diabetes in pregnancy clinic. Patients should be booked in urgently if already pregnant. A significant proportion of pregnancies among women with type 1 and type 2 diabetes are unplanned. Pre-pregnancy planning involves ascertaining whether a woman of reproductive age (< 50 years), with type 1 diabetes, type 2 diabetes, or other form of permanent diabetes, is sexually active, has suitable contraception in place, or is planning to become pregnant.
- Not planning to fall pregnant should have the risks of unplanned pregnancy discussed and suitable contraception in place (including abstinence).
- Planning pregnancy (including those happy to become pregnant ‘should it happen’) should receive pre-pregnancy care.
The risk of adverse pregnancy outcomes (e.g. miscarriage, major congenital malformations and perinatal mortality) is proportional to the level of glycaemic control before pregnancy, reflected by the pre-conception HbA1c. Preconception counselling and planning have been demonstrated to reduce the risk of adverse pregnancy outcomes by 50% to 75%.
NEW ONLINE Pregnancy: Pre-conception Care for women with Type 1 & 2 Diabetes is now available for all GPs and Practice Nurses in SWS.
Aims to improve General Practitioner and Practice Nurse ‘knowledge’ and ‘know how’ in managing women with diabetes who are sexually active or thinking about pregnancy.
- is free to all GPs and Practice Nurses in South Western Sydney
- created for busy clinicians and is quick to complete (10-20 mins)
- is the Australianised version the (UK) Cambridge Diabetes Education Program
Once registered, you have access to all the AusCDEP topics.
Register through the SWSPHN by
Contacting Delena Bailey on 4632 3006 or Delena.Bailey@swsphn.com.au or phone Megan Ray on 4632 3005 for your free REGISTRATION KEY CODE or for more information.