Why Plan?

The next clip will highlight the importance of planning a pregnancy when you have diabetes.





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Most important take home message is to see specialist health professionals as soon as possible - at present, this is the woman's diabetes team..... however, as a student midwife, this should trigger thoughts of who is the best health professional to provide preconception advice? Do you see it within the remit of the midwife? How can midwives improve their accessibility to women to provide preconception advice?
 


Question


Women with pre-existing diabetes are recommended to take folic acid preconceptually. What dose is recomended?
What is the role of the HbA1c blood test?
What level of HbA1C is recommended for healthy pregnancy:



Definition

The following are just some of the complications associated with diabetes:

Retinopathy

Retinopathy is a disease of the retina that reults in impairment or loss of vision. Most people with diabetes will show signs of retinopathy after 25 years of duration, however only a few progress to the severst form. the most effective treatment for retinpathy is improvement of glycaemic control which will slow progression of the condition. Follow this link to watch a short video on diabetic retinopathy.

Pregnancy can accelerate existinf retinopathy - in fact, if a women improves her glycaemic control too quickly in pregnancy, this can have a negative effect on retinopathy. Therefore, it is extremely important to carry out a full retinal assessment ideally preconceptually or in early pregnancy and then repeat assessments during pregnancy to check for any signs of deterioration.

Nephropathy

Diabetic nephropathy is kidney disease caused by diabetes and clinical diagnosis is based on detection of proteinuria in the absence of another obvious cause such as infection. The most effective treatment for nephropathy  in improvement of glycaemic control and careful management of blood pressure which will slow progression of the condition.

Pregnancy can accelerate existing nephropathy. Urinalysis testing preconceptually to detect proteinuria and regular urine testing during pregnancy is recommended. Testing for urinary microalbuminuria would also be recommended.

Women with pre-existing diabetes may be taking some of the following medications

Insulin

Insulin is considered the main drug of choice in managing type 1 diabetes and is also often used in treatment of type 2 diabetes. Some insulins are now licensed as safe for use in pregnancy under medical advice.

Oral antidiabetic drugs

Often used for type 2 diabetics as an alternative to insulin. Some drugs increase insulin action (example metformin); some drugs increase insulin secretion (sulphonylureas). Most oral antidiabetic drugs are contraindicated in pregnancy, except metformin which has been deemed safe in pregnancy and has been used successfully as an alternative to insulin in women with type 2 diabetes or in gestational diabetes.

Anti-hypertensives

Some anti-hypertensivesmay be teratogenic in pregnancy, however, some are considered safe (example: methyldopa). Therefore, if a woman is considering pregnancy, she will need to change to a safe anti-hypertensive medication.

Statins

Satins help to control cholesterol levels and have proved excellent in the treatment of diabetes. However, satins are considered unsafe in pregnancy - therefore if a woman is planning pregnancy, she will need to stop statin medication under medical advice.
Advising women with regard to stopping smoking can be a challenging part of the midwife's role. Always explore expert services within your Trust organisation in relation to smoking cessation, Click here to view the NICE guidance on smoking advice.