امرأة عمرها ٢٩ سنة مصابة بالسكري النوع الثاني، تأخذ ميتفورمين وليسينوبريل وأتورفاستاتين، وتخطط للحمل خلال ٣ أشهر. سكرها التراكمي ٨٫٩٪. ما النصيحة الأهم قبل الحمل؟

A 29-year-old woman with type 2 diabetes on metformin, lisinopril and atorvastatin plans pregnancy within 3 months. HbA1c 8.9%. What is the most important pre-conception advice?

1. Stop all medicines without any replacement until pregnant
2. Conceive now and control glucose after delivery
3. Continue all current medicines without change
4. Optimise glucose, review unsafe drugs, start folic acid

Answer: D) Optimise glucose, review unsafe drugs, start folic acid. High glucose around conception increases malformations and miscarriage. Glucose is optimised (often with insulin), lisinopril and statins stopped, and higher-dose folic acid started.