Diabetes in women older than 40 years of age. Social and medical aspects.

Prevention of Congenital Anomalies. Because the first few weeks after conception are a critical time in terms of embryopathy, good glycemic control should be established before conception in the pregestational diabetic and stringently maintained throughout the first trimester. Encouraging the diabetic woman to achieve stringent glycemic control before conception would virtually eliminate the excess risk of spontaneous abortion and anomalies. Prenatal Diagnosis. For all mature gravidas with diabetes, early prenatal diagnosis of chromosome abnormalities (mainly trisomies) and congenital anomalies should be determined through detailed ultrasound examination, fetal echocardiography, and alpha-fetoprotein determinations. Glycemic Control. Stringent metabolic control is mandatory throughout pregnancy to prevent the risk for macrosomia and maternal-accompanied medical complications, such as preeclampsia. Fetal Surveillance. Structured fetal surveillance evaluating fetal growth and well-being must be pursued throughout pregnancy.