While planning for a pregnancy is important for all women, for those with diabetes, ‘this need to plan has even greater importance'.

According to Rita Forde, an advanced nurse practitioner at the Mater Hospital's Diabetes Centre in Dublin, in an effort to prevent early pregnancy loss and congenital malformations in the baby, ‘optimal medical care, patient education and training must begin before conception'.

Ms Forde noted that as well as having to cope with the ‘normal emotional and physiological diversity of pregnancy', the management of diabetes at this time becomes more ‘intense'. However, coping with this can be difficult, with some women finding it hard to remain motivated.

She pointed out that despite major advances in the treatment of diabetes, particularly during pregnancy, ‘major congenital malformations remain the leading cause of mortality and serious morbidity' in the babies of women with diabetes.

Furthermore, research indicates that this is due to poor glycaemic (blood sugar) control during early pregnancy. For example, hyperglycaemia (high blood sugar) during the first eight weeks of pregnancy can disturb the normal growth and development of the unborn baby.

However, these malformations often occur before the woman even realises she is pregnant.

"Therefore it is essential for women with diabetes that specialist care commences before pregnancy in order to reduce the rate of these anomalies," Ms Forde explained.

She works in the Mater's Diabetes Centre, where a dedicated pre-pregnancy clinic was established in 2004. The purpose of this clinic is to ensure that the women attending ‘are in the best possible general health prior to pregnancy'.

Women attending the clinic are reviewed regularly and as well as diabetes, issues such as folic acid supplementation and weight are dealt with.

"Their diabetes management and control are assessed and alterations to treatment made as necessary to achieve their pre-pregnancy targets," Mr Forde said.

She pointed out that the incidence of infertility has increased worldwide and if a woman with diabetes is planning to seek fertility treatment, ‘it is important that her glycaemic control has been optimised prior to commencing any treatment'.

Ms Forde insisted that pre-pregnancy care should be considered as part of the management of all women of reproductive age with diabetes.

"The challenge now is how best to inform all women of reproductive age with diabetes about the importance of obtaining specialist care prior to becoming pregnant," she added.

Ms Forde made her comments in the Irish Journal of Clinical Medicine: Modern Medicine.

For more information on pregnancy, see our Pregnancy Clinic here