As the report declares the risk for adverse pregnancy outcome in UK women with diabetes has improved considerably over the last two decades due to improved obstetric care and tighter glycemic control. In this context, folic acid is mostly recommended. The major cause of perinatal mortality with diabetes can be attributed to congenital malformations and unexplained foetal death. Congenital malformations account for approximately 40% of perinatal deaths in diabetes with no specific associated malformation. The congenital malformations associated with diabetes are usually multiple, more severe, and more often fatal than birth defects found in offspring of nondiabetic women. As early maternal hyperglycemia is associated with a higher incidence of congenital malformations therefore, the incidence of babies with birth defects born to mothers with diabetes increase the rate significantly with preconception control as evidenced by lower glycosylated hemoglobin levels at the time of organogenesis.
This paper stresses that ideally women with pre existing diabetes should have planned pregnancies for preconceptual assessment, counselling and management. However only 20% of diabetic women seek prepregnancy care. This is not unusual considering that approximately 60% of all pregnancies are unintended. Preconception programs with the goal of normalisation of blood glucose levels in the preconception period have significantly decreased the incidence of congenital anamolies among infants of insulin-dependant diabetics.