A 30-year-old woman with type 1 diabetes mellitus comes to the clinic for preconception care. What is the priority education for her at this time?

• A. Her insulin requirements will likely increase during the second and third trimesters of pregnancy.
• B. Infants of diabetic mothers can be macrosomic, which can result in more difficult delivery and higher likelihood of cesarean section.
• C. Breast feeding is highly recommended, and insulin use is not a contraindication.
• D. Achievement of optimal glycemic control at this time is of utmost importance in preventing congenital anomalies.

Answer: (C)

The key idea being tested is that insulin use is compatible with breastfeeding, and breastfeeding is strongly encouraged for a person with diabetes. This education is prioritized in preconception care because it directly informs plans after pregnancy and helps the patient feel confident about how to manage diabetes if and when she breastfeeds. Insulin does not pose a contraindication to breastfeeding, and continuing insulin therapy is safe for both mother and baby. This reassurance supports adherence to diabetes management and lactation plans, which is immediately useful information for someone planning pregnancy.

While the other points about insulin needs increasing during later pregnancy, the risk of macrosomia, and the importance of achieving glycemic control to prevent congenital anomalies are all important, they are either more specifically tied to the actual pregnancy period or to outcomes that become the focus once pregnancy occurs.