Pregnancy outcome in diabetic patients depends on how well the diabetic control is.
Patients with poorly controlled diabetes at the time of conception are at an increased risk of miscarriage as well as congenital alformations in the fetus. Optimising the blood sugar control before the conception is therefore crucial.
Patients with anti-phospholopid syndrome are at an increased risk of pregnancy complications ranging from miscarriage early or late in pregnancy, intra-uterine growth restriction, development of pre-eclamsia, deep vein thrombosis and so on. It is important to assess the severity of the condition before the start of the pregnancy.
It is also important to start the anti-coagulation medication as soon as the pregnancy is confirmed. Ideally, the options of anti-coagulation prophylaxis and the risks with anti-coagulation need to be discussed and a decision has to be made before conception
Recurrent miscarriage is defined as loss of three or more consecutive pregnancies. Usually the assessment is commenced at the time of third miscarriage. Subsequently, it is important to see the couple in order to obtain detailed history and carry out the detailed examination.
Some of the tests need to be carried out outside pregnancy. If a causative factor is found, treatment can be initiated as soon as the pregnancy is confirmed, or at times, even before the conception. Thus, management can be optimised by consulting the specialist before conception