Management of complications of diabetes before conception

Optimal assessment for, and management of, complications of diabetes is important for women with diabetes who are trying to conceive.

Diabetic retinopathy can appear or progress during pregnancy, so it should be assessed, treated and stable before conception (see Diabetic retinopathy for management advice). Risk factors for progression include glycaemic targets not being achieved before pregnancy, known diabetic retinopathy, long duration of diabetes and elevated blood pressure. Rapid improvement in the glycaemic profile may precipitate acute retinopathy. For women with diabetes and a high HbA1c (eg more than 75 mmol/mol [9%]), it is important to optimise the glycaemic profile and aim for stability for a few months before trying to conceive.

Diabetic kidney disease of any degree (even microalbuminuria) increases the likelihood of elevated blood pressure developing during pregnancy. The risk of elevated blood pressure increases with worsening stage of kidney disease. See Diabetic kidney disease for further information. Pregnant women with diabetes and chronic kidney disease have a higher risk of fetal complications, and are themselves at risk of deteriorating kidney function that may be permanent and require dialysis. Therefore, women with diabetes and stage 3 or more chronic kidney disease should be assessed by a renal physician before trying to conceive.

Women with type 1 and type 2 diabetes are at high risk of pre-eclampsia—prophylaxis for pre-eclampsia is recommended from 12 weeks gestation (see Other complications of diabetes).

Pregnant women with diabetes and autonomic neuropathy may experience problems such as vomiting, postural hypotension, and difficulty achieving adequate nutrition. They should be assessed by a specialist before trying to conceive.