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CHICAGO – In particular, “several retrospective studies have shown that the risk for congenital malformations is increased with higher hemoglobin A1c levels,” said Susan Kirk, MD, speaking at a “Meet the Professor” session at the annual meeting of the Endocrine Society.
However, pointed out Dr. Kirk, fact-based counseling about pregnancy risks for women with type 1 or type 2 diabetes can – and should – occur within the framework of a strong and accepting physician-patient relationship.
Most women with diabetes have received pre-conception counseling about the risks of pregnancy with diabetes and the importance of glycemic control. “Despite that, I think many of us are often surprised by the percentage of unplanned pregnancies,” said Dr. Kirk, of the University of Virginia, Charlottesville, in an interview.
“What I have learned is that the desire to become pregnant is so strong, and the contemplation of all the adverse events that can happen … is really scary, not only to the woman but to her partner as well.”
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Dr. Kirk continued, “The more compassion you can show, and the more emphasis that you can place on the fact that she’s most likely to have a healthy baby, the chances are she’ll work with you from the beginning to get her control where she needs to be.”
Target numbers for hemoglobin A1c have become lower over the past several years, with the American Diabetes Association now recommending pre-conception levels below 6.5%. “There’s no randomized controlled trial that defines what that ideal number should be, but with the passage of time and some larger studies, we now know that ‘as close to normal as possible’ should be the goal,” Dr. Kirk said. This means that if women can tolerate the lower blood glucose levels without serious symptoms of hypoglycemia, a level of less than 6% is more preferable still, she said.
In terms of medication management for women with diabetes who become pregnant, physicians need to think about angiotensin converting enzyme inhibitors and statins, both of which are contraindicated for use during pregnancy. If a patient is pregnant or trying for a pregnancy, “I will stop those, and either leave them off all medicine entirely, or transition them to something that’s safe for use during pregnancy,” said Dr. Kirk.
It’s important to know if women have any microvascular complications because these are likely to progress during pregnancy, said Dr. Kirk. “The good news is, it all goes back to where she started before pregnancy after she has the baby,” though pre-existing advanced renal disease or eye disease may still cause concern for permanent damage. “If there are changes in the back of the eye that are suggestive of proliferative retinopathy, she should absolutely try to get that taken care of before she gets pregnant.”
The use of prenatal vitamins is another area where strong evidence is lacking, said Dr. Kirk. What is known is the folic acid supplementation “has been proven beyond a doubt to lower the rate of neural tube complications. And it’s cheap, and it’s easy to take. So any woman who’s even hinting at getting pregnant should be placed on those,” she said.
Dr. Kirk had no financial disclosures.
koakes@frontlinemedcom.com
SOURCE: Kirk S. ENDO 2018, Session M-02-3.
CHICAGO – In particular, “several retrospective studies have shown that the risk for congenital malformations is increased with higher hemoglobin A1c levels,” said Susan Kirk, MD, speaking at a “Meet the Professor” session at the annual meeting of the Endocrine Society.
However, pointed out Dr. Kirk, fact-based counseling about pregnancy risks for women with type 1 or type 2 diabetes can – and should – occur within the framework of a strong and accepting physician-patient relationship.
Most women with diabetes have received pre-conception counseling about the risks of pregnancy with diabetes and the importance of glycemic control. “Despite that, I think many of us are often surprised by the percentage of unplanned pregnancies,” said Dr. Kirk, of the University of Virginia, Charlottesville, in an interview.
“What I have learned is that the desire to become pregnant is so strong, and the contemplation of all the adverse events that can happen … is really scary, not only to the woman but to her partner as well.”
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Dr. Kirk continued, “The more compassion you can show, and the more emphasis that you can place on the fact that she’s most likely to have a healthy baby, the chances are she’ll work with you from the beginning to get her control where she needs to be.”
Target numbers for hemoglobin A1c have become lower over the past several years, with the American Diabetes Association now recommending pre-conception levels below 6.5%. “There’s no randomized controlled trial that defines what that ideal number should be, but with the passage of time and some larger studies, we now know that ‘as close to normal as possible’ should be the goal,” Dr. Kirk said. This means that if women can tolerate the lower blood glucose levels without serious symptoms of hypoglycemia, a level of less than 6% is more preferable still, she said.
In terms of medication management for women with diabetes who become pregnant, physicians need to think about angiotensin converting enzyme inhibitors and statins, both of which are contraindicated for use during pregnancy. If a patient is pregnant or trying for a pregnancy, “I will stop those, and either leave them off all medicine entirely, or transition them to something that’s safe for use during pregnancy,” said Dr. Kirk.
It’s important to know if women have any microvascular complications because these are likely to progress during pregnancy, said Dr. Kirk. “The good news is, it all goes back to where she started before pregnancy after she has the baby,” though pre-existing advanced renal disease or eye disease may still cause concern for permanent damage. “If there are changes in the back of the eye that are suggestive of proliferative retinopathy, she should absolutely try to get that taken care of before she gets pregnant.”
The use of prenatal vitamins is another area where strong evidence is lacking, said Dr. Kirk. What is known is the folic acid supplementation “has been proven beyond a doubt to lower the rate of neural tube complications. And it’s cheap, and it’s easy to take. So any woman who’s even hinting at getting pregnant should be placed on those,” she said.
Dr. Kirk had no financial disclosures.
koakes@frontlinemedcom.com
SOURCE: Kirk S. ENDO 2018, Session M-02-3.
CHICAGO – In particular, “several retrospective studies have shown that the risk for congenital malformations is increased with higher hemoglobin A1c levels,” said Susan Kirk, MD, speaking at a “Meet the Professor” session at the annual meeting of the Endocrine Society.
However, pointed out Dr. Kirk, fact-based counseling about pregnancy risks for women with type 1 or type 2 diabetes can – and should – occur within the framework of a strong and accepting physician-patient relationship.
Most women with diabetes have received pre-conception counseling about the risks of pregnancy with diabetes and the importance of glycemic control. “Despite that, I think many of us are often surprised by the percentage of unplanned pregnancies,” said Dr. Kirk, of the University of Virginia, Charlottesville, in an interview.
“What I have learned is that the desire to become pregnant is so strong, and the contemplation of all the adverse events that can happen … is really scary, not only to the woman but to her partner as well.”
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Dr. Kirk continued, “The more compassion you can show, and the more emphasis that you can place on the fact that she’s most likely to have a healthy baby, the chances are she’ll work with you from the beginning to get her control where she needs to be.”
Target numbers for hemoglobin A1c have become lower over the past several years, with the American Diabetes Association now recommending pre-conception levels below 6.5%. “There’s no randomized controlled trial that defines what that ideal number should be, but with the passage of time and some larger studies, we now know that ‘as close to normal as possible’ should be the goal,” Dr. Kirk said. This means that if women can tolerate the lower blood glucose levels without serious symptoms of hypoglycemia, a level of less than 6% is more preferable still, she said.
In terms of medication management for women with diabetes who become pregnant, physicians need to think about angiotensin converting enzyme inhibitors and statins, both of which are contraindicated for use during pregnancy. If a patient is pregnant or trying for a pregnancy, “I will stop those, and either leave them off all medicine entirely, or transition them to something that’s safe for use during pregnancy,” said Dr. Kirk.
It’s important to know if women have any microvascular complications because these are likely to progress during pregnancy, said Dr. Kirk. “The good news is, it all goes back to where she started before pregnancy after she has the baby,” though pre-existing advanced renal disease or eye disease may still cause concern for permanent damage. “If there are changes in the back of the eye that are suggestive of proliferative retinopathy, she should absolutely try to get that taken care of before she gets pregnant.”
The use of prenatal vitamins is another area where strong evidence is lacking, said Dr. Kirk. What is known is the folic acid supplementation “has been proven beyond a doubt to lower the rate of neural tube complications. And it’s cheap, and it’s easy to take. So any woman who’s even hinting at getting pregnant should be placed on those,” she said.
Dr. Kirk had no financial disclosures.
koakes@frontlinemedcom.com
SOURCE: Kirk S. ENDO 2018, Session M-02-3.
REPORTING FROM ENDO 2018
