Slide 127

Recommendations for the preconception care of women with diabetes1 are summarized in two slides Slide 2 of 2 Medications used by such women should be evaluated prior to conception, since drugs commonly used to treat diabetes and its complications may be contraindicated or not recommended in pregnancy, including statins, ACE inhibitors, ARBs, and most noninsulin therapies (E) Since many pregnancies are unplanned, consider the potential risks and benefits of medications that are contraindicated in pregnancy in all women of childbearing potential, and counsel women using such medications accordingly (E) Women contemplating pregnancy need to be seen frequently by a multidisciplinary team experienced in the management of diabetes before and during pregnancy; among the oral antidiabetic agents, metformin and acarbose are classified as category B (no evidence of risk in humans) and all others as category C Potential risks and benefits of oral antidiabetic agents in the preconception period must be carefully weighed; data are insufficient to establish the safety of these agents in pregnancy For further discussion of preconception care, see the ADA’s consensus statement on pre-existing diabetes and pregnancy2 and the position statement3 on this subject127Reference American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care 2013;36(suppl 1):S44. Kitzmiller JL, Block JM, Brown FM, et al. Managing preexisting diabetes for pregnancy: summary of evidence and consensus recommendations for care. Diabetes Care 2008;31:1060-1079. American Diabetes Association. Preconception care of women with diabetes. Diabetes Care 2004;27(Suppl. 1):S76-S78.