Pregestational diabetes: pregnancy planning. Which strategies

In the last years the number of pregestational pregnancies (especially type 2) has been increasing. Several studies have demonstrated that pregestational pregnancies are associated with an increased incidence of adverse maternal outcomes, an increased risk of neonatal mortality and congenital malformations; these risks are related to the glycemic control and to the therapies at the time of conception and during embryogenesis. These pregnancies, therefore, should never be random, as it often happens in our clinics, but they must be planned with pre-conceptional counselling paths dedicated to childbearing women, from puberty, continuing into adolescence and reaching adulthood. When the pregnancy desire becomes concrete, the woman with diabetes must be included in a multidisciplinary and structured program. The pregestational counselling must bring the woman, before conception, to the stabilization of complications, to the therapy improvement, to the achievement of the skills for the management of therapy and to the glycemic control. To reach these results it is necessary that the Diabetologic team works taking into account all the clinical and psycho-social aspects of childbearing women. KEY WORDS pregestational diabetes; pregnancy; preconceptional counselling; maternal and fetal outcomes.