A woman who now has type 2 diabetes after her first pregnancy was complicated by gestational diabetes comes to see you about having another child. How should you advise her?
- Pregnancy outcomes for women with diabetes and their babies have improved dramatically over the past 50 years.
- Pre-pregnancy planning helps minimise the teratogenic effects of poorly controlled diabetes in the first weeks of pregnancy, when most organ systems are being formed and when pregnancy may not yet have been diagnosed.
- During pregnancy, the priorities are to minimise the effects of diabetes on the pregnancy and the effects of pregnancy on the diabetes, and to monitor for complications, hypoglycaemia and urinary tract infections.
- After delivery, breastfeeding offers special benefits to women with diabetes and an opportunity for you to offer advice about the risk of diabetes to the baby (and its siblings) and about planning future pregnancies.
- The GP plays a key role throughout all stages of pregnancy and counselling for supporting the woman. The GP is the health professional most likely to trigger appropriate pregnancy planning beforehand and to offer the necessary follow up afterwards.