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Resources to support preconception care for women with diabetes Pregnancy Planning Checklist Plan and prepare at least 3-6 months before you start trying for a baby What you need to do BEFORE you fall pregnant Use contraception until you are ready to start trying for a baby (ask your doctor if this is the most reliable contraception suitable for you) Talk to your doctor for general pregnancy planning advice Make an appointment with health professionals who specialise in pregnancy and diabetes Aim for an HbA1c of less than 53mmol/mol (7%) if you have type 1 diabetes or 42mmol/mol (6%) or less if you have type 2 diabetes Review your diabetes management with your diabetes health professionals Have all your medications checked to see if they are safe to take during pregnancy Start taking a high-dose (2.5mg-5mg) folic acid supplement each day Have a full diabetes complications screening and your blood pressure checked Aim for a healthy weight before you fall pregnant For women with type 1 or type 2 diabetes Use this checklist as a guide to discuss with your health professionals www.pregnancyanddiabetes.com.au This checklist is intended as a guide only. It should not replace individual medical advice and if you have any concerns about your health or further questions, you should contact your health professional. The National Diabetes Services Scheme (NDSS) is an initiative of the Australian Government administered with the assistance of Diabetes Australia. Figure 1. Pregnancy planning checklist, to help women with diabetes prepare for a healthy pregnancy. Produced by the National Diabetes Service Scheme. Other resources The Australasian Diabetes in Pregnancy Society (ADIPS)-endorsed Pregnant with Diabetes app has been developed for pregnant women with diabetes, and women with diabetes who intend to become pregnant (Figure 3). It is written by Prof. Elisabeth R Mathiesen and Prof. Peter Damm and is based on the recommendations of the Centre for Pregnant Women with Diabetes at Rigshospitalet in Copenhagen, Denmark. The Australian version has been adapted by an Australian working party to reflect the ADIPS guidelines. The app can be downloaded from app stores free of charge. The information covered in the app is suitable for women with gestational, type 1 and type 2 diabetes and covers topics such as: how to plan for pregnancy, Figure 2. Booklets for women with type 1 and type 2 diabetes. Produced by the National Diabetes Services Scheme. goal blood glucose levels, gestational weight gain, diet and carbohydrate intake, physical activity and insulin dosing. 52 Diabetes & Primary Care Australia Vol 2 No 2 2017

Resources to support preconception care for women with diabetes National Development Program Expert Reference Group (2013–16). We acknowledge D. Charron-Prochownik for permission to reproduce questions from the RHAB questionnaire and V. Holmes for permission to use reproductive health knowledge questions in the NDSS Contraception, Pregnancy & Women’s Health Survey. Abouzeid M, Versace VL, Janus ED et al (2014) A population-based observational study of diabetes during pregnancy in Victoria, Australia, 1999–2008. BMJ Open 4: e005394 Australian Institute of Health and Welfare (2016) Australia’s mothers and babies 2014-in brief. Perinatal statistics. AIHW, Canberra, ACT. Available at: http://www.aihw.gov.au/ publication-detail/?id=60129557656 (accessed 14.03.17) “Primary care health professionals are also ideally placed to increase the awareness of women with diabetes about the available resources which are being actively reviewed and developed to meet their needs.” Cheung N, McElduff A, Ross G (2005) Type 2 diabetes in pregnancy: a wolf in sheep’s clothing. Aust N Z J Obstet Gynaecol 45: 479–83 Figure 3. The Australasian Diabetes in Pregnancy Society (ADIPS)-endorsed Pregnant with Diabetes app. Conclusion Primary health care providers play an important role in promoting effective contraception use and encouraging women with pre-existing type 1 or type 2 diabetes to plan and prepare for pregnancy. They are also ideally placed to increase the awareness of women with diabetes about the available resources which are being actively reviewed and developed to meet their needs. n Acknowledgements The authors are grateful to the women who took part in the NDSS Contraception, Pregnancy & Women’s Health Survey, to the Australasian Diabetes in Pregnancy Society for approving the use of the image of the Pregnant with Diabetes app and to Effie Houvardas and Kaye Farrell, for their contribution to Diabetes in Pregnancy Dunne FP, Avalos G, Durkan M et al (2009) ATLANTIC DIP: pregnancy outcome for women with pregestational diabetes along the Irish Atlantic seaboard. Diabetes Care 32: 1205–6 Holmes VA, Hamill, LL, Alderdice FA et al (2017) Effect of implementation of a preconception counselling resource for women with diabetes: A population based study. Primary Care Diabetes 11: 37–45 Kim C, Ferrara A, McEwan LN et al (2005) Preconception care in managed care: the translating research into action for diabetes study. Am J Obstet Gynecol 192: 227–32 Kitzmiller JL, Wallerstein R, Correa A, Kwan S (2010) Preconception care for women with diabetes and prevention of major congenital malformations. Birth Defects Res A Clin Mol Teratol 88: 791–803 Macintosh MC, Fleming KM, Bailey JA et al (2006) Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. BMJ 333: 177 McElduff A, Ross GP, Lagstrom JA et al (2005) Pregestational diabetes and pregnancy: an Australian experience. Diabetes Care 28: 1260–1 National Diabetes Services Scheme (2015) NDSS Diabetes in Pregnancy National Development Program, Registrant Consultation and Needs Assessment Report. NDSS, Canberra, ACT Ray JG, O’Brien TE, Chan WS (2001) Preconception care and the risk of congenital anomalies in the offspring of women with diabetes mellitus: a meta-analysis. QJM 94: 435–44 Temple RC, Murphy H (2010) Type 2 diabetes in pregnancy - an increasing problem. Best Pract Res Clin Endocrinol Metab 24: 591–603 Wahabi HA, Alzeidan RA, Bawazeer GA et al (2010) Preconception care for diabetic women for improving maternal and fetal outcomes: a systematic review and meta-analysis. BMC Pregnancy Childbirth 10: 63 Zhu H, Graham D, Teh RW, Hornbuckle J (2012) Utilisation of preconception care in women with pregestational diabetes in Western Australia. Aust N Z J Obstet Gynaecol 52: 593–6 Authors Melinda Morrison, NDSS Diabetes in Pregnancy Priority Area Leader*, Diabetes, NSW, Glebe, NSW; Ralph Audehm, General Practitioner, Carlton Family Medical and Department of General Practice, University of Melbourne, Vic; Alison Barry, Credentialled Diabetes Educator and Midwife, Mater Mothers’ Hospital, South Brisbane, Qld; Christel Hendrieckx, Senior Research Fellow, The Australian Centre for Behavioural Research in Diabetes, Deakin University, Geelong, Vic; Alison Nankervis, Senior Physician to the Diabetes Service, The Royal Women’s Hospital and Clinical Head, Diabetes, Royal Melbourne Hospital, Parkville, Vic; Cynthia Porter, Advanced Accredited Practising Dietitian/Credentialled Diabetes Educator, Geraldton Diabetes Clinic, Geraldton, WA; Renza Scibilia, Manager Type 1 Diabetes and Consumer Voice, Diabetes Australia, Melbourne, Vic; Glynis P Ross, Visiting Endocrinologist, Royal Prince Alfred Hospital, Camperdown, NSW, and Senior Endocrinologist, Bankstown-Lidcombe Hospital, Bankstown, NSW. *Melinda Morrison is representing Diabetes Australia/National Diabetes Service Scheme. Diabetes & Primary Care Australia Vol 2 No 2 2017 53

Resources to support preconception care for women with diabetes<br />

National Development Program Expert<br />

Reference Group (2013–16). We acknowledge<br />

D. Charron-Prochownik for permission<br />

to reproduce questions from the RHAB<br />

questionnaire and V. Holmes for permission to<br />

use reproductive health knowledge questions<br />

in the NDSS Contraception, Pregnancy &<br />

Women’s Health Survey.<br />

Abouzeid M, Versace VL, Janus ED et al (2014) A population-based<br />

observational study of diabetes during pregnancy in Victoria,<br />

Australia, 1999–2008. BMJ Open 4: e005394<br />

Australian Institute of Health and Welfare (2016) Australia’s<br />

mothers and babies 2014-in brief. Perinatal statistics. AIHW,<br />

Canberra, ACT. Available at: http://www.aihw.gov.au/<br />

publication-detail/?id=60129557656 (accessed 14.03.17)<br />

“Primary care health<br />

professionals are<br />

also ideally placed to<br />

increase the awareness<br />

of women with<br />

diabetes about the<br />

available resources<br />

which are being<br />

actively reviewed and<br />

developed to meet<br />

their needs.”<br />

Cheung N, McElduff A, Ross G (2005) Type 2 diabetes in<br />

pregnancy: a wolf in sheep’s clothing. Aust N Z J Obstet<br />

Gynaecol 45: 479–83<br />

Figure 3. The Australasian Diabetes in Pregnancy<br />

Society (ADIPS)-endorsed Pregnant with Diabetes app.<br />

Conclusion<br />

Primary health care providers play an important<br />

role in promoting effective contraception use<br />

and encouraging women with pre-existing<br />

type 1 or type 2 diabetes to plan and prepare<br />

for pregnancy. They are also ideally placed to<br />

increase the awareness of women with diabetes<br />

about the available resources which are being<br />

actively reviewed and developed to meet their<br />

needs.<br />

n<br />

Acknowledgements<br />

The authors are grateful to the women who took<br />

part in the NDSS Contraception, Pregnancy<br />

& Women’s Health Survey, to the Australasian<br />

Diabetes in Pregnancy Society for approving the<br />

use of the image of the Pregnant with Diabetes<br />

app and to Effie Houvardas and Kaye Farrell,<br />

for their contribution to Diabetes in Pregnancy<br />

Dunne FP, Avalos G, Durkan M et al (2009) ATLANTIC DIP:<br />

pregnancy outcome for women with pregestational diabetes<br />

along the Irish Atlantic seaboard. Diabetes Care 32: 1205–6<br />

Holmes VA, Hamill, LL, Alderdice FA et al (2017) Effect of<br />

implementation of a preconception counselling resource for<br />

women with diabetes: A population based study. Primary Care<br />

Diabetes 11: 37–45<br />

Kim C, Ferrara A, McEwan LN et al (2005) Preconception care in<br />

managed care: the translating research into action for diabetes<br />

study. Am J Obstet Gynecol 192: 227–32<br />

Kitzmiller JL, Wallerstein R, Correa A, Kwan S (2010)<br />

Preconception care for women with diabetes and prevention of<br />

major congenital malformations. Birth Defects Res A Clin Mol<br />

Teratol 88: 791–803<br />

Macintosh MC, Fleming KM, Bailey JA et al (2006) Perinatal<br />

mortality and congenital anomalies in babies of women with<br />

type 1 or type 2 diabetes in England, Wales, and Northern<br />

Ireland: population based study. BMJ 333: 177<br />

McElduff A, Ross GP, Lagstrom JA et al (2005) Pregestational<br />

diabetes and pregnancy: an Australian experience. Diabetes<br />

Care 28: 1260–1<br />

National Diabetes Services Scheme (2015) NDSS Diabetes<br />

in Pregnancy National Development Program, Registrant<br />

Consultation and Needs Assessment Report. NDSS, Canberra,<br />

ACT<br />

Ray JG, O’Brien TE, Chan WS (2001) Preconception care and the<br />

risk of congenital anomalies in the offspring of women with<br />

diabetes mellitus: a meta-analysis. QJM 94: 435–44<br />

Temple RC, Murphy H (2010) Type 2 diabetes in pregnancy - an<br />

increasing problem. Best Pract Res Clin Endocrinol Metab 24:<br />

591–603<br />

Wahabi HA, Alzeidan RA, Bawazeer GA et al (2010)<br />

Preconception care for diabetic women for improving maternal<br />

and fetal outcomes: a systematic review and meta-analysis.<br />

BMC Pregnancy Childbirth 10: 63<br />

Zhu H, Graham D, Teh RW, Hornbuckle J (2012) Utilisation of<br />

preconception care in women with pregestational diabetes in<br />

Western Australia. Aust N Z J Obstet Gynaecol 52: 593–6<br />

Authors<br />

Melinda Morrison, NDSS<br />

Diabetes in Pregnancy Priority<br />

Area Leader*, Diabetes, NSW,<br />

Glebe, NSW; Ralph Audehm,<br />

General Practitioner, Carlton<br />

Family Medical and Department<br />

of General Practice, University<br />

of Melbourne, Vic; Alison Barry,<br />

Credentialled Diabetes Educator<br />

and Midwife, Mater Mothers’<br />

Hospital, South Brisbane, Qld;<br />

Christel Hendrieckx, Senior<br />

Research Fellow, The Australian<br />

Centre for Behavioural Research<br />

in Diabetes, Deakin University,<br />

Geelong, Vic; Alison Nankervis,<br />

Senior Physician to the Diabetes<br />

Service, The Royal Women’s<br />

Hospital and Clinical Head,<br />

Diabetes, Royal Melbourne<br />

Hospital, Parkville, Vic; Cynthia<br />

Porter, Advanced Accredited<br />

Practising Dietitian/Credentialled<br />

Diabetes Educator, Geraldton<br />

Diabetes Clinic, Geraldton, WA;<br />

Renza Scibilia, Manager Type 1<br />

Diabetes and Consumer Voice,<br />

Diabetes Australia, Melbourne,<br />

Vic; Glynis P Ross, Visiting<br />

Endocrinologist, Royal Prince<br />

Alfred Hospital, Camperdown,<br />

NSW, and Senior Endocrinologist,<br />

Bankstown-Lidcombe Hospital,<br />

Bankstown, NSW.<br />

*Melinda Morrison is representing<br />

Diabetes Australia/National<br />

Diabetes Service Scheme.<br />

Diabetes & Primary Care Australia Vol 2 No 2 2017 53

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