Klinke Jennifer, Toth Ellen L
Department of Medicine, University of Alberta, Edmonton.
Can Fam Physician. 2003 Jun;49:769-73.
To emphasize preconception care of women with type 1 diabetes and the role of primary care physicians in evaluating and counseling them.
Substantial level II evidence indicates that tight glycemic control before conception and early in pregnancy reduces the rate of congenital malformations. Most evidence concerning maternal and fetal risks during pregnancy in patients with type 1 diabetes is level III or IV. Little is published on the role of family physicians in providing preconception counseling or care.
Preconception care is effective in improving glycemic control early in pregnancy and in reducing the rate of congenital malformations. Preconception evaluation of type 1 diabetic patients involves assessment of prepregnancy glycemic control and diabetic complications. Preconception counseling includes discussing the rate of transmission of diabetes, the effects of pregnancy on maternal and fetal complications, and the use of contraception until optimal glycemic control can be attained.
Primary care physicians often have frequent and early contact with women of reproductive age; they are ideal candidates for providing type 1 diabetic women with preconception evaluation and counseling.
强调1型糖尿病女性的孕前保健以及初级保健医生在评估和咨询她们方面的作用。
大量的II级证据表明，孕前及孕早期严格的血糖控制可降低先天性畸形的发生率。关于1型糖尿病患者孕期母婴风险的大多数证据为III级或IV级。关于家庭医生在提供孕前咨询或保健方面的作用，发表的内容很少。
孕前保健在改善孕早期血糖控制及降低先天性畸形发生率方面是有效的。对1型糖尿病患者的孕前评估包括评估孕前血糖控制情况及糖尿病并发症。孕前咨询包括讨论糖尿病的遗传率、妊娠对母婴并发症的影响以及在达到最佳血糖控制之前使用避孕措施。
初级保健医生经常与育龄女性有频繁且早期的接触；他们是为1型糖尿病女性提供孕前评估和咨询的理想人选。
