After Accutane®, glucose is probably the worst teratogen! Controlling hyperglycemia PRIOR TO CONCEPTION is key in preventing congenital malformations. While specialized “pre-pregnancy” clinics exist, not all patients come to these. Primary care, diabetes specialty teams and obstetric teams need to accept shared responsibility to help ensuring patients are counseled about these risks.
As a general approach, here are key points to emphasize:
1. While the risks are real and substantial, don’t scare the patient. Emphasize that these risks can be prevented and you will help with this.
2. Best to achieve target glycemic control PRIOR to conception.
3. If possible, switch to insulin prior to conception. But if the patient gets pregnant on oral agents (which were controlling glucose), stopping them could run the risk of hyperglycemia while waiting to start insulin.
4. Start folic acid 5 mg OD (note: this is a prescription dose and is more than what is in most multivitamins).
5. If BP control is needed, use medications that are most safe in pregnancy (labetolol, nifedipine, methyldopa)
6. If the patient has complications (eye, kidney, heart), refer to a specialist in those areas prior to conception.
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