The National Institute of Health and Clinical Excellence in the UK indicated that glycohemoglobin levels <6.1% are correlated with the lowest risk of malformations while the reproductive risks are higher in women above this threshold and prohibitive for glycohemoglobin levels >10%.Consumption of folic acid and antioxidant substances before fertilization result in a reduced rate of malformations in the offspring of mothers with diabetes. Antioxidants such as lipoic acid, vitamin C, and vitamin E, increase the probability of favorable prenatal outcomes in offspring of diabetic mothers because oxidative stress is a teratogenic mediator of hyperglycemia in mothers with diabetes. After fertilization
Optimal weight and glycemic management encourage good outcomes because diabetes has the potential to influence the mother and fetus during the entire pregnancy. The integrity of embryofetal development and placental function can be monitored by fetal echocardiography and ultrasound scanning. See also
Diabetic diet


== References ==
Treatment can be complicated as symptoms may be concurrent with the initial injury that caused the infection. Cephalic tetanus is more likely than other forms of tetanus to be fatal, with the progression to generalized tetanus carrying a 15–30% case fatality rate. Cause
Tetanus is caused by the tetanus bacterium Clostridium tetani. Tetanus is an international health problem, as C. tetani endospores are ubiquitous. Endospores can be introduced into the body through a puncture wound (penetrating trauma). Due to C. tetani being an anaerobic bacterium, it and its endospores thrive in environments that lack oxygen, such as a puncture wound. With the changes in oxygen levels, the drumstick-shaped endospore can result in quick spread.The disease occurs almost exclusively in persons inadequately immunized. It is more common in hot, damp climates with soil rich in organic matter. Manure-treated soils may contain spores, as they are widely distributed in the intestines and feces of many animals such as horses, sheep, cattle, dogs, cats, rats, guinea pigs, and chickens. In agricultural areas, a significant number of human adults may harbor the organism.The spores can also be found on skin surfaces and in contaminated heroin. Heroin users, particularly those who inject the drug subcutaneously, appear to be at high risk of contracting tetanus. Rarely, tetanus can be contracted through surgical procedures, intramuscular injections, compound fractures, and dental infections. Animal bites can transmit tetanus.Tetanus is often associated with rust, especially rusty nails.