Preconception Care of Women With Type 2 Diabetes

Background

Definition of Pre-Conception Care

It is necessary to begin by defining the term “pre-conception care” (PCC) to provide an accurate, complimentary insight into the topic before examining the issue appropriately. The most comprehensive interpretation is the “provision of biomedical, behavioral and social interventions to women and couples before conception occurs to address health problems, health-related behaviors, and risk factors that could contribute to maternal or childhood mortality and morbidity” (Mason, E. et al., 2014, para. 8). The period that is named “pre-conception care” is before a first and between two pregnancies, or in other words, it begins before reproductive years and ends when woman losses her capability to give birth, excluding the period of pregnancy itself.

PCC covers a wide spectrum of topics that shall be considered to ensure good conditions for future pregnancy. There are the following sets of interventions that aim to identify and exclude potential risks: behavioral, chronic diseases, genetics, medications, sexually transmitted infections (STIs), and vaccination (“Preconception Care: A guide for optimizing pregnancy outcomes,” no date). The first type is focused on adjusting women’s lifestyles, such as detecting and reducing alcohol and smoking misuse and preventing cases of domestic violence, drug abuse, and other risk factors. The second set of interventions considers specific diseases, such as diabetes which is of particular attention in this paper, asthma, obesity, and others. Genetic disorders and the use of medications to manage risk factors, which will also be discussed in detail further, are part of pre-conception care. Finally, STIs and vaccination worth consideration within the outlined scope for women’s safety. Therefore, PCC is a vital and comprehensive area that shall be paid attention to when discussing future mothers’ health and the success of pregnancies.

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Definition of Diabetes Mellitus Type 2

Diabetes Mellitus, well-known as diabetes, is an impairment in the way body manages sugar income. The regulation of glucose as a fuel is vital for the correct functioning of an organism, but this long-term (chronic) disease results in the excessive amount of sugar in the blood that leads to disorders of three major systems, which are circulatory, nervous, and immune ones (Mayo Clinic Staff, 2021). This disease shall be monitored and managed within the scope of pre-conception care’s interest, as it may severely deteriorate future pregnancy conditions.

There are two main causes of type 2 diabetes: pancreas does not produce enough hormone named “insulin,” which regulates the movement of sugar into cells, or cells might not interact correctly with it and do not take enough sugar in (Mayo Clinic Staff, 2021, para. 2). Symptoms include but are not limited to: increased thirst and hunger, frequent urination, unintended weight loss, fatigue, blurred vision, frequent infections, and numbness in the hands or feet (Mayo Clinic Staff, 2021, para. 5). In general, despite diabetes is a chronic disease and cannot be cured completely, but diet and exercise are known to be helpful in managing the adverse consequences. If they are not, medications or insulin therapy may be needed to stabilize the conditions and improve the state of health.

Examination of the Existing Issue

Diabetes is one of the most widespread conditions, and the increase in the frequency of its occurrence is a significant medical concern within PCC’s area of interest, as the number of pregnancies affected by this disease raised as well. For instance, according to Earle et al. (2017), “Between 1995 and 2012 the prevalence of T2DM increased by 354%.” (para. 1). The inappropriate management of this condition results in significant risks for women and children and is financially ineffective (“Diabetes in the UK 2010: Key statistics on diabetes,” 2010). Therefore, in view of the severity of the issue, it is vital to examine methods how to ensure the advanced PCC.

The Evidence Supporting Pre-Conception Care

Before deepening into medications used in PCC for women with diabetes Type 2, pregnancy preparations, and strategies, evidence of the efficiency of such interventions shall be provided to prove their necessity. According to Tyden (2016), the most significant fact, which explains why such care shall be in practice is that “the most critical period for organ development occurs before many women even know they are pregnant” (para. 2). It implies that sometimes, the severe harm from different conditions to future pregnancy is done before a woman receives the appropriate care. World Health Organization claims that “4 out of 10 women report that their pregnancies are unplanned” (no date, Facts section). It means that PCC is vital for preventing a potential danger from mentioned above risk factors in the view that 40% of women do not plan their pregnancy and thus, do not receive care in advance.

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It is possible to outline several more instances that show how necessary PCC is for women of childbearing age. Maternal undernutrition and anemia increase the risk of maternal death, as these conditions are responsible for 20% of mortality, while PCC is intended to detect such negative factors and eliminate them before pregnancy occurs (World Health Organization, no date, Facts section); (“The Importance of Preconception Care,” no date). Simultaneously, in the absence of interventions, rates of HIV transmission from mother to child is up to 45%, while undetected violence against females leads to various negative consequences, such as the risk for premature delivery and low-birth-weight infants (World Health Organization, no date, Facts section). With medications that control epilepsy, women are at increased risk of having babies with congenital anomalies that might be prevented through PCC and adverse effects from smoking that result in 24% of sudden infant death syndrome cases (World Health Organization, no date, Facts section). Therefore, it is vital to apply to PCC in order to prevent the mentioned consequences of certain unmanaged conditions and keep mothers and their children safe and healthy.

Medication Safety

Diabetes medications for women preparing for future pregnancy require particular attention, as some are not safe for a future child. There are six drug classes for oral diabetes medications: Sulfonylureas that help beta cells in the pancreas to produce more insulin, Megilitinides for the same purpose, Biguanides that lower blood sugar, and Thiazolidinediones that enabled muscles and fat utilize insulin effectively (Vann, 2013). The other two are alpha-glucosidase inhibitors slowing down the rise of blood sugar and DPP-4 inhibitors that enables glucagon-like peptide 1 to work in a body longer (Vann, 2013). In addition, there are five types of insulin that are distinguished by the time of acting. Therefore, there is a specter of medications, the influence of which shall be considered by a specialist when taking into account future pregnancy.

Because the safety of most diabetes pills is not established, a doctor might switch them to insulin, which is more reliable, especially taking into consideration resistance to the hormone during pregnancy, that reduces the effectiveness of the oral drugs (“Prenatal Care,” no date); (Herndon, 2018). For instance, among medications that shall be taken with precaution or are not prescribed are SGLT2 inhibitors that may increase the risk of genital yeast infections or even diabetic ketoacidosis (Hafide, 2020). In addition, such medications cross the placenta to the unborn baby that is also the reason for not using them. Therefore, as the safety and efficiency of oral drugs for women who are preparing to become or are pregnant can be questioned, insulin in injections is the most beneficial option.

Pregnancy Preparation

Pregnancy preparation for women with diabetes is vital for the success of a pregnancy. It is possible to outline several steps of methodology that summarize the National Institute for Health and Clinical Excellence’s (NICE) recommendations described in their guidance to present the full process of preparing a woman for childbearing. First, the role of diet, weight, and exercise is considered, as for women with the disease, it is even more critical because of the condition’s specificity that was described previously (Mugglestone, 2008); (Mahmud and Mazza, 2010). For women with a body mass index above 27 kg/m2, the recommendation regarding the weight loss shall be provided, and the need for folic acid supplementation, to prevent bornin a child with a neural tube defect, shall be considered by a specialist (Mugglestone, 2008, p. 714). Then, glycaemic control shall be implemented to ensure that glycated hemoglobin is less than 7% (with an optimal of 6.1%) (Mugglestone, 2008, p. 715). The advice regarding self-monitoring of blood glucose shall be provided to enable a woman to manage fasting blood glucose. The medications used for diabetes are discussed in detail in the previous section.

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The other steps of preparation for pregnancy include the following steps. Retinal assessment is recommended during PCC, with frequency once a year, to ensure that no retinopathy is found. This examination shall be conducted after the first antenatal clinic appointment, and after 28 weeks, in the event that the previous assessment’s results were normal, or after 16-20 weeks for women with diabetic retinopathy detected during the initial meeting (Mugglestone, 2008, p. 715). Renal assessment, including measurement of microalbuminuria, shall also be conducted for women before contraception discontinues. The consultation with a nephrologist is necessary if creatinine concentration and estimated glomerular filtration rates exceed the normal range (Mugglestone, 2008, p. 715). In addition, risk factors such as previous macrosomic baby weighing 4.5 kg or more, precious gestational diabetes, family history of diabetes, and origin with a high prevalence of the disease shall be considered (Mugglestone, 2008, p. 715). Conduction of self-monitoring of blood sugar is highly recommended, and hypoglycaemic therapy is implemented if blood glucose is not maintained in the normal range. Therefore, sets of measurements shall be taken to prepare a woman with diabetes for further pregnancy to ensure its success and safety.

Strategies to Ensure Appropriate Pre-Conception Care and Weakness of the System

It is possible to outline several weaknesses in the PCC system that complicates or make it impossible to access high-quality care for women. Simultaneously, there are several strategies that respond to the detected issues and assist in ensuring appropriate PCC. Nekuei, Shahnaz, and Kazemi (2015) claim about PCC that “Due to not receiving relevant training during education and job periods, health care providers do not know much about these services and are not able to provide them properly.” It reveals one of the vital issues, that is lack of training of personnel, while the other problem is lack of proper conditions at health care centers to provide PCC to diabetic women (Nekuei, Shahnaz, and Kazemi, 2015). Others are: lack of comprehensive PCC plan and team work care program, which is also referred to as inadequate training. It is additionally complicated with diabetic women’s negligence about planning a pregnancy (Nekuei, Shahnaz, and Kazemi, 2015). Finally, public notifications are not properly used for information distribution (Nekuei, Shahnaz, and Kazemi, 2015). Therefore, there is a variety of issues that shall be considered.

With respect to mentioned weaknesses, appropriate strategies can be proposed. According to Nekuei, Shahnaz, and Kazemi (2015), a “properly designed training program is effective in increasing the awareness of health care providers.” That indicates the necessity of improvements in personnel’s training system, PCC plans, and programs. The described lack of information can be improved by raising awareness of the necessity for women to refer to a specialized center for care. According to Nekuei, Shahnaz, and Kazemi (2015), “this should be done by the health system in several ways, such as electronic medical records, public education, and others.” Finally, counseling before pregnancy and education of family members and women result in timely referring for PCC, and therefore, lead to ensuring that females obtain access to appropriate care (Nekuei, Shahnaz, and Kazemi, 2015). The launching of centers for fertility health consultation and screening diabetes is also vital for providing appropriate information for women of childbearing age and improving PCC quality (Nekuei, Shahnaz, and Kazemi, 2015). Improvements in information providing and training of personnel shall be implemented, though mentioned strategies, to provide women with access to appropriate care.

Conclusion

PCC is vital for a safe and successful pregnancy, as there are a number of risk factors that affect women. Females with diabetes type 2 shall be paid particular attention to because of potential adverse consequences in the event of the absence of necessary care. Despite a number of medications for managing the condition, only insulin can be safely and effectively used. The system is unperfect because of the lack of information providers and inappropriate training, which shall be improved through strategies to ensure access for women to high-quality PCC.

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Reference List

Diabetes in the UK 2010: Key statistics on diabetes. Web.

Earle, S. et al. (2017) ‘Preconception care for women with type 1 or type 2 diabetes mellitus: a mixed-methods study exploring uptake of preconception care,’ Health Technol Assess. 21(14), pp.1-130.

Hafide, S. Type 2 diabetes: Which medication is best for me? (2020) Web.

Herndon, J. Can You Have a Safe Pregnancy If You Have Type 2 Diabetes? (2018) Web.

Mugglestone, A. M. (2008) ‘Management of diabetes from preconception to the postnatal period: summary of NICE guidance’, BMJ, 336(7646), pp.714-717.

Mahmud, M. and Danielle, M. (2010) ‘Preconception care of women with diabetes: a review of current guideline recommendations’, BMC Women’s Health, 336(7646).

Mason, E. et al. (2014) ‘Preconception care: advancing from “important to do and can be done” to “is being done and is making a difference”’, Reprod Health, 11(S8).

Mayo Clinic Staff (2021) Type 2 diabetes. Web.

Nekuei, N., Shahnaz, K., and Kazemi, A. (2015) ‘Preconception care in diabetic women’, J Educ Health Promot, 4(8).

Preconception Care: A guide for optimizing pregnancy outcomes (no date) Web.

Prenatal Care. (no date) Web.

The Importance of Preconception Care (no date) Web.

Tyden, T. (2016) ‘Why is preconception health and care important?’, Reprod Health, 12(4), p.207.

Vann, M. Diabetes Medication Safety Tips (2013) Web.

World Health Organization. Preconception care: Maximizing the gains for maternal and child health (no date) Web.

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