A woman with pre-existing type 1 diabetes mellitus plans pregnancy. The HbA1c before conception that is associated with the lowest risk of congenital malformations and safest target for pre-conception counseling is:

• A Less than 8% (64 mmol/mol)
• B Less than 7.0% (53 mmol/mol)
• C Less than 5.5% (37 mmol/mol)
• D Less than 6.5% (48 mmol/mol) ✓

Explanation

NICE and international guidelines recommend achieving HbA1c <6.5% (48 mmol/mol) before conception in women with pre-existing diabetes to minimize the risk of congenital malformations, stillbirth, and macrosomia. Above 10% (86 mmol/mol), the risk of congenital anomalies increases markedly. The threshold of 6.5% represents the balance between glycemic optimization and avoiding hypoglycemia risk. This target should be individualized when hypoglycemia is a concern.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.