What is the recommended HbA1c target for women with pre-existing diabetes before conception, and what is the recommended dose and duration of folic acid supplementation?

The recommended HbA1c target is 48 mmol/mol or lower before conception. Folic acid should be prescribed as 5 mg daily for at least 3 months before conception and continued until 12 weeks of pregnancy.

For women with pre-existing diabetes, optimizing glucose before pregnancy is important to reduce risks of congenital anomalies and other adverse outcomes. The source recommends achieving an HbA1c of 48 mmol/mol or less prior to conception. To lower the risk of neural tube defects, folic acid 5 mg should be taken daily for at least 3 months prior to conception and for the first 12 weeks of pregnancy.