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PubMed1998

Reproductive health in diabetic women. A report of two cases demonstrating the importance of preconception care.

BACKGROUND: Optimal glycemic control prior to and during early pregnancy is essential in diabetic women. CASES: Two cases of fetal anencephaly occurred in diabetic women who conceived with medical technical assistance but did not receive preconception counseling. Both women had poor glycemic control periconceptually, as evidenced by elevated glycosylated hemoglobin determinations in the early first trimester. Targeted sonographic evaluations in the second trimester revealed both fetuses to be anencephalic. Both women terminated their pregnancies. CONCLUSION: Women with diabetes should be encouraged to seek preconceptual counseling and achieve tight glycemic control prior to attempting pregnancy. Health care providers play a vital role in stressing the importance of preconception care to these patients.

Adult↗
PubMed2002

[Preconception care of the type I diabetic patient from the viewpoint of the diabetologist].

High standard metabolic compensation of diabetes reduces in a significant way the risk of developmental defects and the perinatal morbidity of children of diabetic mothers and the maternal mortality. A considerable proportion of diabetic women is inadequately informed on the risks of pregnancy. As many as two thirds of pregnancies in diabetic women are unplanned and thus the risk of inadequate compensation of diabetes in early stages of pregnancy increases. Preparation of diabetic women for planned pregnancy is therefore very important. Ensuring long-term normal blood sugar levels in type 1 diabetics has many pitfalls and involves in particular optimal insulin treatment and systematic and high standard control of the blood sugar level and other parameters.

Diabetes Mellitus, Type 1↗
PubMed2001

[Effects of levofolinic acid on plasma homocysteine concentrations in healthy and young women in preconceptional care].

BACKGROUND: Increases in total plasmatic homocysteine (tHcy) represents a risk factor for neural tube defects. We studied the effects of levofolinic acid (l,5-formyl-tetrahydrofolic) on the plasmatic tHcylevels in women of child-bearing age. MATERIALS AND METHOD: Healthy women aged 18-35 years (n = 30) received levofolinic acid, 5 mg/day,orally for 30 days. Both tHcy and intraerythrocytic folate levels were measured before treatment (day 0), on days 2, 5, 10 and 30 within the treatment period and on days 30 (day 60) and 60 (day 90) after the treatment was finished. Plasmatic tHcy was measured by fluorescence polarisation immunoassay and intraerythrocyticfolates by chemiluminescent immunoassay. RESULTS: Plasmatic tHcy decreased from the second day of treatment onwards (day 0 vs. 2: mean of difference: -1.24 micromol/l; CI 95% = -0.84 to -1.63; p < 0.001). The maximum decline (32.3%) was observed after 30 days (mean of difference = -2.72 micromol/l; CI 95% = -2.20 to -3.24; p < 0.001).After finishing the treatment, the hypohomocysteinic effect persisted up to days 60 (mean of difference = -2.67 micromol/l; CI 95% = -2.07 to -3.26; p < 0.001)and 90 (mean of difference = -1.49 micromol/l; CI 95% = -0.94 to -2.03; p < 0.001). The response was greater when the plasmatic tHcy concentration was >= 9 micromol/l. CONCLUSIONS: Levofolinic acid leads to a earlier, intense and persistent drop of the plasmatictHcy levels.

Adult↗
PubMed2006

Preconception care and treatment with assisted reproductive technologies.

Couples with fertility problems seeking treatment with assisted reproductive technologies (ART) such as in vitro fertilization should receive preconception counseling on all factors that are provided when counseling patients without fertility problems. Additional counseling should address success rates and possible risks from ART therapies. Success rates from ART are improving, with the highest live birth rates averaging about 40% per cycle among women less than 35 years old. A woman's age lowers the chance of achieving a live birth, as do smoking, obesity, and infertility diagnoses such as hydrosalpinx, uterine leiomyoma, or male factor infertility. Singletons conceived with ART may have lower birth weights. Animal studies suggest that genetic imprinting disorders may be induced by certain embryo culture conditions. The major risk from ovarian stimulation is multiple gestation. About one-third of live-birth deliveries from ART have more than one infant, and twins represent 85% of these multiple-birth children. There are more complications in multiple gestation pregnancies, infants are more likely to be born preterm and with other health problems, and families caring for multiples experience more stress. Transferring fewer embryos per cycle reduces the multiple birth rate from ART, but the patient may have to pay for additional cycles of ART because of a lower likelihood of pregnancy.

Age Factors↗
PubMed1991

Preconception care of diabetes. Glycemic control prevents congenital anomalies.

To test the value of intensive management of diabetes before and during early pregnancy, 84 women recruited prior to conception were compared with 110 women who were already pregnant referred at 6 to 30 weeks' gestation. All underwent daily measurement of fasting and postprandial capillary blood glucose levels. Mean blood glucose levels during embryogenesis and organogenesis were within 3.3 to 7.8 mmol/L in 50% of preconception subjects and exceeded 10 mmol/L in 6.5%. One major congenital anomaly occurred in 84 infants (1.2%) of women treated before conception compared with 12 anomalies in 110 infants (10.9%) of mothers in the postconception group. Transient symptomatic hypoglycemia occurred during embryogenesis in 60% of women in the preconception group, with a median frequency of 2.7 episodes per week, but was not associated with excess malformations. We conclude that education and intensive management for glycemic control of diabetic women before and during early pregnancy will prevent excess rates of congenital anomalies in their infants.

Adult↗
PubMed2001

Folic acid and preconceptional care.

If all women capable of becoming pregnant consumed 400 µg (0.4 mg) of the B vitamin folic acid daily before conception and during the first trimester, the annual number of neural-tube birth defect (NTD)-affected pregnancies in this country could be reduced by 50% to 70%. Despite this important relationship, most women are not aware that folic acid prevents NTDs, and folic acid supplementation rates remain low. If folic acid consumption is to succeed as a public health intervention on a societal scale, physicians who care for reproductive-age women must become informed about the folic acid-NTD prevention linkage. Next, they must be encouraged to counsel patients about the need to consume sufficient folic acid before conception. Studies reveal that few physicians have adequate knowledge of the appropriate timing and dosage of folic acid supplementation. Studies also show that women are more likely to get important folic acid information not from their physicians but from other sources. This article provides information about ways in which physicians can improve their folic acid knowledge and education practices.

Journal Article↗