International Gynecology Group Updates Preconception Checklist, Puts Chronic Disease Management at Center

What the Checklist Actually Says

The International Federation of Gynecology and Obstetrics (FIGO) has released an updated Preconception Checklist in the International Journal of Gynecology & Obstetrics. The document puts chronic disease management front and center, identifying preexisting conditions like diabetes, lupus, and obesity as the most consequential factors a woman can address before getting pregnant.

The Diabetes Problem Is Specific

Dr. Ellen W. Seely, professor of medicine at Harvard Medical School and director of clinical research in the endocrinology, diabetes, and hypertension division at Brigham and Women's Hospital in Boston, laid out the stakes plainly.

"If glucose levels are running high in the first trimester, this is associated with an increased risk of birth defects, some of which are very serious," Seely said. Getting those levels under control before conception can reduce the risk of birth defects in women with diabetes to near that of the general population.

The American Diabetes Association has set a specific target: an HbA1c below 6.5% before conception. That is a measurable benchmark with clinical consequences.

Medication Switches Are Not Optional

Seely was direct about medication management. Women with type 1 or type 2 diabetes who also have hypertension, which is common, are often on ACE inhibitors. Those drugs are associated with increased risk of fetal renal damage and in severe cases neonatal death. They need to stop before pregnancy, not after a positive test.

For women with type 2 diabetes on non-insulin medications, the ADA recommends switching to insulin before conception. The reason is straightforward: insulin has the longest and most robust safety record in pregnancy. Other drug classes simply do not have the same data.

Seely's recommended monitoring protocol is also specific: home glucose checks four times daily, fasting, and two hours after each meal, with insulin adjustments made accordingly.

The Barrier Nobody Talks About

A key barrier to preconception care protocols is access and awareness. Many women with chronic conditions do not know they need to plan a pregnancy differently from the general population. Some are not told. Some have limited access to specialists. Some have irregular contact with the healthcare system.

Seely acknowledged this directly: a barrier is "not knowing that a pregnancy should be planned." The ADA's position is that conversations about pregnancy should begin at puberty for women with diabetes, with the topic revisited annually. In practice, that standard is rarely met.

This gap is legitimate and well-documented. It does not undermine the clinical guidance. Instead, it underscores why primary care and OB-GYN providers need to integrate these conversations into routine annual visits rather than waiting until a patient announces a pregnancy.

Lifestyle Still Matters

Diet and physical activity remain core components of glycemic control in the preconception period. The updated checklist treats these not as moral prescriptions but as clinical tools, because the data supports them as such.

Obesity is specifically listed alongside diabetes and lupus as a condition requiring active management before conception. That framing reflects the evidence: obesity independently elevates risks for gestational diabetes, preeclampsia, preterm birth, and cesarean delivery.

What the Source Does Not Cover

The Medscape article that summarizes this guidance appears to be a partial rendering of a longer piece. The sourced text cuts off mid-sentence before completing the discussion of drugs studied for preconception care in diabetic women. That missing section likely covers GLP-1 receptor agonists and SGLT-2 inhibitors, both of which have become widely used in type 2 diabetes management but carry unresolved questions about fetal safety. Women currently on those drugs who are planning a pregnancy need explicit guidance, and it is not visible in the available source material.

The Unresolved Clinical Question

The checklist framework is sound. The evidence base for diabetes and glycemic control is solid. What remains genuinely unresolved is how the medical system closes the gap between ADA recommendations—annual pregnancy conversations starting at puberty—and what actually happens in clinical practice. No guideline document closes that gap on its own. Whether payers, health systems, or specialty societies move to require structured preconception counseling for women with chronic conditions is an open policy question, not a settled one.