Preconception care for women with diabetes and prevention of major congenital malformations.
This article provides an overview of the rationale for diabetes preconception care interventions for women with diabetes and the efficacy in reducing the excess occurrence of major congenital malformations. The problems with broad use of individualized preconception care are considered. In addition, suggestions are made for the implementation of more comprehensive interventions in the community and usual diabetes care settings, to address the multiple ongoing challenges in the prevention of structural anomalies associated with preexisting diabetes. Based on the published evidence, successful preconception care can be considered to include: achievement of individualized target standardized glycosylated hemoglobin levels, adequate nutrition, and minimizing hypoglycemia before and after discontinuing effective contraception and during the transition to early prenatal care.
Kitzmiller
John L
JL
Diabetes and Pregnancy Program, Division of Maternal-Fetal Medicine, Santa Clara Valley Health Center, 750 S. Bascom, San Jose, CA 95128, USA. John.Kitzmiller@hhs.sccgov.org
Wallerstein
Robert
R
Correa
Adolfo
A
Kwan
Saiyin
S
D000013:Congenital Abnormalities / Q000196:embryology* / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000592:standards; D006801:Humans; D006943:Hyperglycemia / Q000196:embryology / Q000378:metabolism*; D007003:Hypoglycemia / Q000378:metabolism; D016742:Preconception Care; D011247:Pregnancy; D011254:Pregnancy in Diabetics; D011295:Prenatal Care; D013723:Teratogens / Q000378:metabolism; D014930:Women
D006442:Glycated Hemoglobin; D013723:Teratogens