DIABETES
Diabetes
mellitus is the most prevalent chronic medical disease in the fertility
population. Infants of insulin-dependent diabetics have 10 times the general
population risk of congenital malformation and five times the stillbirth rate.
Diabetics complications such as retinopathy and
nephropathy may worsen during fertility search, particularly if associated with hypertension. Women who
have severe neuropathy or cardiovascular disease may even be advised against
pregnancy. In this respect, fertility counseling and family planning advice
should be an important aspect of their diabetic management.
The aim
of fertility care is to achieve normoglycaemic both pre- and periconception as
many of the problems seen in the insulin-dependent diabetic mother are a direct
result of hyperglycaemia. However, about one-third of diabetic women attend for
fertility care.
The
safety of currently available oral hypoglycaemic agents in pregnancy is not
well established, therefore women with type 11 diabetes who are taking such
treatments should be switched to insulin therapy both for the fertility or
pre-conception period and for pregnancy.
PHENYLKETONURIA (PKV)
Phenylketonuria is an inborn error of metabolism some women with PKV
discontinue treatment during middle childhood. However, unless they resume
careful dietary control around the time of conception the toxic effect of
phenylalanine (Phe) on the developing embryo/fetus results in a high rate of
microcephaly, mental retardation and
congenital heart defects. Even through dietary control, it is not easy for some women
to attain the recommended Phe levels of 120-360 micromol per litre, but when
dietary levels are achieved before conception or 8-10 weeks of pregnancy the
occurrence of congenital heart disease is significantly reduced. Clearly, the woman with PKV needs specialist help and support throughout for
preserving fertility which will eventually leads to the birth of a baby.
ORAL CONTRACEPTION
This
should be stopped at least 3 months and preferably 6 months prior to planning a
pregnancy to allow for the resumption of natural hormone regulation and
ovulation. Also the oral contraceptive pill is associated with vitamin and
mineral imbalances that may need correcting. Copper levels are raised whilst
zinc levels are reduced which results in a deficiency of the latter minerals.
Vitamin metabolism is also affected, which may lead to deficiencies of folate,
B complex and vitamin C and an increase in vitamin A, which can be tetratogenic
at high levels.
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