Diabetes Mellitus: Preconception management in primary care

Diabetes Mellitus is a metabolic and chronic disease, which is identified by elevated blood glucose levels. These elevated blood glucose levels can result in developing macrovascular and microvascular complications (World Health Organization, 2023). The two main types of diabetes mellitus are type 1 and type 2, the most prevalent type is Type 2 Diabetes Mellitus (hereafter referred to as T2DM) (World Health Organization, 2023). Without insulin replacement in Type 1 Diabetes Mellitus (T1DM), death will occur within weeks or days (National Institute for Health and Care Excellence, 2022).

The National Institute for Health and Care Excellence (NICE) provides guidelines for managing preconception and diabetes mellitus. Under these guidelines, NICE advises providing women with diabetes mellitus with the requisite information, support and advice to mitigate the adverse risks to mother and foetus that are associated with diabetes mellitus and pregnancy (National Institute for Health and Care Excellence, 2020). These risks include; miscarriage, stillbirth, perinatal death, congenital malformations, neural tube defect, neonatal hypoglycaemia, blood glucose control affected by nausea and vomiting (National Institute for Health and Care Excellence, 2020). The infant may also be large for their gestational age, resulting in labour inductions, birth traumas, shoulder dystocia, caesarean section and instrumental deliveries (National Institute for Health and Care Excellence, 2020). Monitoring through an early ultrasound scan at approximately 7 weeks gestation is crucial (Guy's and St Thomas NHS Foundation Trust, 2022). The infant is also at risk of developing diabetes mellitus in the future (National Institute for Health and Care Excellence, 2020).