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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Preconception Counseling for Women with Diabetes and Hypertension
Sponsored by The Indian Health Service Clinical Support Center
Step 2. Background
Women with hypertension and diabetes are commonly encountered in primary care practice and present somewhat of a management dilemma when they wish to become pregnant. The emphasis should be on prevention of atherosclerotic disease, and prevention, screening, and early treatment of microvascular disease. Implementation of these practices has the potential to significantly improve quality of life and increase life expectancy in patients with type II diabetes mellitus. (Vijan S, 1997 )
Primary care physicians often have frequent and early contact with women of reproductive age; they are ideal candidates for providing diabetic women with preconception evaluation and counseling. (Klinke J 2003 ) Good guidelines for the use of common primary care therapies in women of child-bearing age with diabetes, hypertension, and hyperlipidemia, are not readily available.
Young American Indian / Alaska Native (AI/AN) patients are at even higher risk for these problems than the general US all races due to their high prevalence of glucose intolerance. Pima Indian adolescents (15 to 19 years of age) have the highest reported prevalence of type 2 diabetes among youth, 51 per 1000. The prevalence rate for all North American Indians was 4.5 per 1000. In comparison, the estimated incidence rate for adolescents in Greater Cincinnati in 1994 was 7.2 per 100,000 per year.
The fact that so many of our AI/AN patients have diabetes and/or hypertension at younger ages is one of our greatest challenges. On the other hand, their diabetes and hypertension are well controlled enough that they can successfully pursue pregnancy.
Nevertheless, such problems are being more commonly encountered as the “obesity epidemic” progresses, especially in our AI/AN population.
Is the risk of adverse cardiovascular events the same in these young women as it is in their over 50 year old counterparts?
What is the risk of teratogenicity if they should become pregnant on the various medicines we prescribe?
Let’s explore some of these, and other, issues together.
