Effective Pregnancy Management

Preconception Preparation

The American Diabetes Association recommends that all women of reproductive age receive preconception counseling, including optimization of glucose levels to A1C <6.5%, and folic acid supplementation, to reduce the risk of complications during pregnancy 1
Preconception counseling should emphasize the importance of achieving normal glucose levels, ideally A1C <6.5%, to reduce the risk of congenital anomalies, preeclampsia, macrosomia, and preterm labor 1
Women with pre-existing diabetes should receive preconception care in a multidisciplinary clinic, including an endocrinologist, a maternal-fetal medicine specialist, a dietitian, and a diabetes specialist, to reduce the risk of complications during pregnancy 2

Women with pre-existing diabetes should be informed of the risk of developing or progressing diabetic retinopathy during pregnancy, and receive comprehensive eye exams before, during, and after pregnancy 2
Extended ophthalmologic examinations should be performed ideally before pregnancy or in the first trimester, then every trimester, and within 1 year after delivery, to monitor for diabetic retinopathy 2

The American Diabetes Association recommends monitoring glucose levels fasting and postprandially, as well as targeting glucose levels: plasma glucose fasting <95 mg/dl (5.3 mmol/l), 1 hour after eating <140 mg/dl (7.8 mmol/l), or 2 hours after eating <120 mg/dl (6.7 mmol/l) 2
The ideal target A1C level during pregnancy is <6% (42 mmol/mol), if it can be achieved without significant hypoglycemia, due to increased red blood cell turnover 2
Continuous glucose monitoring can help achieve target A1C levels in women with diabetes during pregnancy 3

Medication lists should be reviewed for potentially harmful medications, such as ACE inhibitors, angiotensin receptor blockers, and statins, and alternative treatments should be considered 2