Unmasking Barriers in the Delivery of Preconception Counseling and Contraception Provision for Patients With Type 1 or Type 2 Diabetes

Suboptimal glycemic control among women with type 1 or type 2 diabetes before conception and during the early part of pregnancy is a powerful risk factor for fetal anomalies, macrosomia, and stillbirth. Major congenital anomalies occur in up to 25–30% of infants of women with type 1 or type 2 diabetes (1). Hyperglycemia during fetal organogenesis (5–8 weeks after the last menstrual period) is a considerable teratogen, and, consequentially, the risk of fetal anomalies related to preexisting maternal diabetes can be reduced to background risk when glycemic control is at goal.