Reproductive health in diabetic women - A report of two cases demonstrating the importance of preconception care

BACKGROUND: Optimal glycemic control prior to and during early pregnancy is essential in diabetic women. CASES: Two cases of fetal anencephaly occurred in diabetic women who conceived with medical technical assistance but did not receive preconception counseling. Both women had poor glycemic control periconceptually, as evidenced by elevated glycosylated hemoglobin determinations in the early first trimester. Targeted sonographic evaluations in the second trimester revealed both fetuses to be anencephalic. Both women terminated their pregnancies. CONCLUSION: Women with diabetes should be encouraged to seek preconceptual counseling and achieve tight glycemic control prior to attempting pregnancy. Health care providers play a vital role in stressing the importance of preconception care to these patients.