Written by IROAGANACHI.V.C., OD, Msc DIA

Maintain HbA1c to 53mmol/mol to reduce risk of maternal or foetal diabetes complications, reduce the risk of  polycystic ovarian syndrome by ensuring adequate fertility for example normal ovarian health which encourages foetal health between conception  and organogenesis.

Life style risk factor modification need to be introduced; In event patients have unhealthy life style. Women who smokes cigarette should be adviced on the risk factors associated with smoking and the negative effects on diabetes management. Encourage smoking cessation therapy i.e  starting with stop smoking advice and behavioural technique. Referral pathways should be made available for patients to commence Nicotine replacement therapy or varenicline. Heavy alcoholic consumers should be encouraged to reduce alcohol to 2 units daily with plans to stop eventually, which in turn reduces their risk of hypoglycemia, heart disease, dyslipidemia, maternal and foetal diabetes complications.

Positive orientation should be given to intending mothers regarding effective management of their diabetes during pregnancy. Naturally no intending mother would want to experience events of hyperglycaemia complications, for example: still birth, macrosomia, CS, IUGR, hyperemesis, preclampsia or polyhydramnios, miscarriages, maternal or neonatal death during delivery or pregnancy circle. Highlighting dangers of diabetes mismanagement may help trigger effective commitments.

Other risk factors like blood pressure, cholesterol, excessive weight gain and physical inactivity should be addressed and monitored accordingly as per international and local guidelines on diabetes maternal care or ICGP integrated care for pre maternal care.

Encourage intake of folic acid 5mg daily and Vitamin D, 3 months before conception and till 10 to 12 weeks gestation.

Patients should be advised to visit their G.ps to ensure their glucose lowering medications are appropriate for their upcoming conception.

Lastly, clinical optometrist in charge of retinopathy screening in various hospital eye department, should ensure intending mothers are screened for diabetic retinopathy before conception and up to 4 to 12 weeks gestation, all grading should be recorded and adequate referrals made to ophthalmologist  in cases of R2 or R3 grading for optimal ocular management. 

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