Abstract
The goal of prenatal care is to prepare the woman for pregnancy, which in the case of diabetes, means to achieve normoglycemia. Hyperglycemia poses a number of risks for both the fetus and the mother.
As some of these complications have been developing since conception, it is very important to achieve satisfactory metabolic control at the time of conception at the latest. During prenatal care, we also search for the presence of thyroid disease/disorders, celiac disease and arterial hypertension, which are more likely to be associated with diabetes and, if untreated, pose a further risk to pregnancy.
During pregnancy, chronic diabetic complications, especially diabetic retinopathy and diabetic kidney disease, may worsen; therefore, it is critical to know the patient's baseline status, and regular monitoring of renal function and retinal checks by the ophthalmologist are needed. Advanced stages of diabetic complications may be contraindications to pregnancy.
Satisfactory control of Type 1 diabetes can be achieved by adjusting diet and insulin regimen - in some cases insulin pump therapy may be appropriate. Diabetes control can be further improved with continuous glucose monitoring both in diabetes treated with the insulin pump or with multiple daily insulin injections.
For overweight or obese patients with Type 2 diabetes, comprehensive treatment is appropriate with the aim to lose at least 10% of body weight. It may also be necessary to discontinue oral antidiabetics except metformin and, possibly, to initiate insulin therapy.