| Abstract: |
This article presents a case report of a 45-year-old caucasian woman with a medical history of type 2 diabetes, polycystic ovarian syndrome (PCOS), hypertension, and gastroesophageal reflux disease. She had a history of one normal, healthy pregnancy and delivery without complication. The authors describe her clinical care, notably the antihyperglycemic medications, including pioglitazone, which has a potential effect of increasing fertility in women with PCOS. The authors review the patient’s nonadherence to some of the antihyperglycemic agents, her concerns about hypoglycemia, patient education needs, her unexpected pregnancy, and the changes in medications that were required as a result of the pregnancy, notably, weaning off the analgesics that were prescribed for her neuropathic pain. The patient experienced a miscarriage at approximately 8 weeks’ gestation, after which she expressed interest in attempting another pregnancy. She was encouraged to improve her glycemic control and blood pressure before attempting another pregnancy. The authors describe the relationship between PCOS and insulin resistance, the mechanisms by which metformin and thiazolidinediones increase fertility in women with PCOS, and the importance of preconception care in all women with diabetes. Tight glycemic goals should be met before conception to reduce the risks of spontaneous abortions and fetal malformations. Medication alterations to improve safety during pregnancy should include discontinuation of oral hypoglycemic agents, statins, and angiotensin-converting enzyme (ACE) inhibitors. 9 references. |