Why Plan?


Most women with diabetes are aware that they should plan for pregnancy but, many women don't know why it is so important. Read more here.

The next clip, "Why plan?" introduces the first step to planning: getting that all important health check or M.O.T!

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The National Institute for Clinical Excellence (NICE) guidelines for Diabetes and Pregnancy state that women with diabetes

‘Explain to women with diabetes who are planning to become pregnant that establishing good blood glucose control before conception and continuing this throughout pregnancy will reduce the risk of miscarriage, congenital malformation, stillbirth and neonatal death. It is important to explain that risks can be reduced but not eliminated.’

 

Despite the known benefits of pre-pregnancy planning, the majority of women are unprepared. Some of the benefits include: (Click on the links for the research papers)

•    Lower HbA1c in the first trimester (Temple et al., 2006)

•    Reduced congenital malformation (Ray et al., 2001)

•    Reduced perinatal mortality (Wahabi et al., 2012)

 

 

 "Individualised targets for self-monitoring of blood glucose should be agreed with women who have diabetes and are planning to become pregnant, taking into account the risk of hypoglycaemia" (NICE Clinical Guidelines)

 

All about Targets! Getting it just right..


Below is a general guide but remember that blood glucose targets are individual and as such should be discussed with every patient, working together with their diabetes care team to agree on achievable targets.

Before Breakfast 3.5 to 5.9 mmol/L
One hour after meals      Less than 7.8mmol/L
Two hours after meals Less than 6.4mmol/L

 

 "Reassure women that any reduction in HbA1c level towards the target of 48 mmol/mol (6.5%) is likely to reduce the risk of congenital malformations in the baby....

Strongly advise women with diabetes whose HbA1c level is above 86 mmol/mol (10%) not to get pregnant because of the associated risk" (NICE Clinical Guidelines)

 

‌ What's the evidence?
  • Neff et al., (2014) reported that pre-pregnancy care delivered by a multidisciplinary team effectively reduced HbA1c pre-conceptually with lower HbA1c recorded at booking appointment
  • A recent meta-analysis, Wahabi et al., (2012) demonstrated that pre-pregnancy care lowers HbA1C in the first trimester of pregnancy by an average of 1.92%

 

‘But I was told—whenever you’re older, come back when you’re planning a baby, but never—teenagers, they don’t tell you! Same with alcohol and things. Like they’ll wait until you’re the right age and then tell you, but even—there’s no right age, I think, to…if you’re having a baby.’ (Spence et al., 2010)

 

Women with diabetes continue to become pregnant unprepared and without having planned for pregnancy. Research has also highlighted the lack of planning for pregnancy, with a US study reporting that only 40% of women with diabetes planned for pregnancy (Holing et al., 1998), whereas in the UK, a reported 27% of women were attending pre-pregnancy care (Murphy et al., 2010).

These low attendance rates may be explained by one recent report from the UK, where preconception counselling/contraception was discussed with only 25% of women with diabetes attending for annual review (Varughese et al., 2007).

Self-Assessment

Women with pre-existing diabetes are recommended to take folic acid preconceptually. What dose is recomended?

Glycosylated haemoglobin is used as an indicator of:

What level of HbA1C is recommended for healthy pregnancy?

 

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