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Counsel on Increased Risk With Pregnancy
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Management
- Screen for eye disease and thyroid disease prior to conception
- Recommend 4mg daily folic acid to reduce risk of neural tube defects (typical prenatal vitamins only contain 400 mcg)
- Tight management of blood glucose before getting pregnant:
- Hgb A1c<7.0
- Pre-meal glucose target: 60-119 mg/dl
- 1 hour postprandial glucose target: 100-149 mg/dl
- Discontinue statins if patient actively seeking pregnancy
- Discontinue aspirin if patient becomes pregnant
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are known human teratogens that cause abnormal development, growth restriction, oligohydramnios, fetal death, and neonatal renal failure.
- If hypertension can be successfully managed with another medication, avoid ACE inhibitors and ARBs during pregnancy, and switch women anticipating pregnancy to an alternative antihypertensive agent before conception.
- When ACE inhibitors and ARBs are unavoidable, counsel the patient about the importance of effective contraception, emphasizing that long-acting reversible contraception is most effective for preventing pregnancy.
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