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DIABETES AND
OBESITY

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recommends aiming for an HbA1c <6.5 prior to conception (5),
while the Endocrine Society recommends an HbA1c level “as close
to normal as possible” without causing undue hypoglycemia (6).
Particularly in women with type 2 diabetes who may have a high
bMI, weight loss and associated improvements in insulin sensitivity
may help improve ovulation and conception rates (14). Women
with type 1 diabetes who have microvascular disease have lowered
overall fertility rates; however, improved long-term glycemic con-
trol and prevention of end organ damage is associated with an im-
provement in observed fertility rates (33).

Key Points:
• Menstrual abnormalities, oligomenorrhea, and PCOS are
common in women with diabetes.
• There is controversy as to whether women with type 1 diabetes
may experience an earlier age at menopause.
• Preconception glycemic optimization is critical in decreasing t
he risk of pregnancy loss and diabetic embryopathy.

References
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of diabetes: estimates for the year 2000 and projections for
2030. diabetes Care. 2004;27(5):1047-53.
2. Writing Group for the SfdiYSG, dabelea d, bell RA,
d'Agostino Rb, Jr., Imperatore G, Johansen JM, et al. Incidence
of diabetes in youth in the United States. JAMA.
2007;297(24):2716-24.
3. Kitzmiller Jl, Wallerstein R, Correa A, Kwan S. Preconception JS. Menstrual cycle differences between women with type 1 di-
care for women with diabetes and prevention of major con- abetes and women without diabetes. diabetes Care.
genital malformations. birth defects Res A Clin Mol Teratol. 2003;26(4):1016-21.
2010;88(10):791-803. 8. Sim SY, Chin Sl, Tan Jl, brown SJ, Cussons AJ, Stuckey bG.
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study. diabetes Care. 2009;32(11):2005-9. 9. Gaete X, vivanco M, Eyzaguirre FC, lopez P, Rhumie HK,
5. American diabetes A. 13. Management of diabetes in Preg- Unanue N, et al. Menstrual cycle irregularities and their rela-
nancy: Standards of Medical Care in diabetes-2018. diabetes tionship with HbA1c and insulin dose in adolescents with type
Care. 2018;41(Suppl 1):S137-S43. 1 diabetes mellitus. Fertil Steril. 2010;94(5):1822-6.
6. blumer I, Hadar E, Hadden dR, Jovanovic l, Mestman JH, 10. Solomon CG, Hu Fb, dunaif A, Rich-Edwards J, Willett WC,
Murad MH, et al. diabetes and pregnancy: an endocrine society Hunter dJ, et al. long or highly irregular menstrual cycles as a
clinical practice guideline. J Clin Endocrinol Metab. marker for risk of type 2 diabetes mellitus. JAMA.
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7. Strotmeyer ES, Steenkiste AR, Foley TP, Jr., berga Sl, dorman 11. lizneva d, Suturina l, Walker W, brakta S, Gavrilova-Jordan l,

20 San Antonio Medicine • December 2018