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Rationale:
- There is an association between elevated maternal glucose or glycohemoglobin levels during embryogenesis and high rates of
pregnancy loss and major congenital malformations.
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Evidence:
- In a meta-analysis of 14 cohort studies, the pooled rates of major and minor fetal anomalies were lower in diabetic women
who had received pre-conception care (2.1%) compared with those who had not (6.5%; RR, 0.36 [CI, 0.22 to 0.59]) (1).
- Population-based cohort studies have found an association between adverse fetal outcomes and maternal hyperglycemia (2; 3).
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Comments:
- Pre-conception counseling should include advice on folic acid intake, vaccinations for rubella and varicella, weight control,
and a review of current diseases and medications in addition to an assessment of diabetes management.
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Elisha L. Brownfield, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Justin B. Moore, MD, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device
manufacturers, or health-care related organizations. Richard B. Lynn, MD, FACP, Co-Editor, PIER, has no financial relationships
with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
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The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
ACP. Because all PIER modules are updated regularly, printed web pages
or PDFs may rapidly become obsolete. Therefore, PIER users should
compare the date of the last update on the website with any printout
to ensure that the information being referred to is the most current
available.
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PIER is copyrighted © 2012 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.
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Diabetes in Pregnancy
> Patient Education
