What is the best management approach for a 34-year-old female with prediabetes, hyperlipidemia, and a desire to become pregnant?

From the Guidelines

For a 34-year-old female with prediabetes, hyperlipidemia, and a desire to become pregnant, the best management approach is to focus on comprehensive preconception care, including lifestyle modifications, medical assessment, and planning, as outlined in the standards of medical care in diabetes-2020 1. To achieve this, the patient should undergo a comprehensive nutrition assessment and receive recommendations for meal planning, correction of dietary nutritional deficiencies, and safe food preparation techniques.

• A comprehensive diabetes self-management education should be provided, including counseling on diabetes in pregnancy, preconception glycemic targets, and the risks associated with diabetes in pregnancy.
• Lifestyle recommendations should include regular moderate exercise, avoidance of hyperthermia, and adequate sleep.
• The patient should be screened for diabetes complications and comorbidities, including a comprehensive foot exam, comprehensive ophthalmologic exam, lipid panel, serum creatinine, TSH, and urine protein-to-creatinine ratio 1.
• Immunizations, such as rubella, varicella, hepatitis B, and influenza, should be up to date.
• A preconception plan should be developed, including a nutrition and medication plan to achieve glycemic targets prior to conception, a contraceptive plan to prevent pregnancy until glycemic targets are achieved, and a management plan for general health, gynecologic concerns, comorbid conditions, or complications.
• Given the patient's hyperlipidemia, it is essential to manage lipid levels to reduce the risk of cardiovascular disease, and this can be achieved through lifestyle modifications and, if necessary, medication, under the guidance of a healthcare provider 1.
• The patient should be advised to take prenatal vitamins with folic acid (400-800 mcg daily) and to discontinue any medications that may be contraindicated in pregnancy, such as statins, under medical supervision.
• Regular medical follow-up every 3 months is crucial to monitor glucose levels and lipid profiles, ensuring the best possible outcomes for both the mother and the fetus.

From the Research

Management Approach for Prediabetes and Hyperlipidemia

To manage prediabetes and hyperlipidemia in a 34-year-old female desiring pregnancy, the following approaches can be considered:

• Lifestyle modification, including calorie restriction, increased physical activity (≥150 min/wk), self-monitoring, and motivational support, as it has been shown to decrease the incidence of diabetes by 6.2 cases per 100 person-years during a 3-year period 2
• Dietary changes, such as adhering to a Mediterranean diet or a Dietary Approaches to Stop Hypertension (DASH) style diet, which have been associated with improved lipid profiles and reduced risk of cardiovascular disease 3, 4
• The Mediterranean diet, in particular, has been shown to have a protective effect on cardiovascular disease risk and may reduce the risk of diabetes in individuals with prediabetes 5, 6

Dietary Recommendations

• The Mediterranean diet is characterized by high consumption of fruits, vegetables, whole grains, and healthy fats, such as those found in olive oil, and low consumption of red meat and processed foods 5
• The DASH diet emphasizes whole grains, fruits, vegetables, lean protein, and low-fat dairy, and is low in saturated fat, cholesterol, and sodium 3
• Both diets have been shown to be effective in improving lipid profiles and reducing cardiovascular disease risk, and may be beneficial for individuals with prediabetes and hyperlipidemia 3, 4

Considerations for Pregnancy

• Women with prediabetes and hyperlipidemia who are planning to become pregnant should work with their healthcare provider to develop a personalized management plan that takes into account their individual needs and health status
• Lifestyle modifications, such as dietary changes and increased physical activity, are generally recommended for all individuals with prediabetes and hyperlipidemia, regardless of pregnancy plans 2
• Medications, such as metformin, may be considered for individuals with prediabetes and hyperlipidemia, but should be used under the guidance of a healthcare provider, especially in women who are planning to become pregnant 2