Effect of implementation of a preconception counselling resource for women with diabetes: A population based study

      Highlights

      • Pregnancy planning and pre-pregnancy care uptake is poor among women with diabetes.
      • Poor preconception counselling is linked to poor pre-pregnancy care uptake.
      • Implementation of a preconception counselling resource improved pregnancy planning.
      • Women who engaged with the resource were better prepared for pregnancy.
      • Women with type 2 diabetes, typically cared for in primary care, are hard to reach.

      Abstract

      Aim

      To evaluate the effect of regional implementation of a preconception counselling resource into routine diabetes care on pregnancy planning indicators.

      Methods

      A preconception counselling DVD was distributed to women by diabetes care teams and general practices. Subsequently, in a prospective population-based study, pregnancy planning indicators were evaluated. The post-DVD cohort (n = 135), including a viewed-DVD subgroup (n = 58), were compared with an historical cohort (pre-DVD, n = 114). Primary outcome was HbA1c at first diabetes-antenatal visit. Secondary outcomes included preconception folic acid consumption, planned pregnancy and HbA1c recorded in the 6 months preconception.

      Results

      Mean first visit HbA1c was lower post-DVD vs. pre-DVD: 7.5% vs. 7.8% [58.4 vs. 61.8 mmol/mol]; p = 0.12), although not statistically significant. 53% and 20% of women with type 1 and 2 diabetes, respectively, viewed the DVD. The viewed-DVD subgroup were significantly more likely to have lower first visit HbA1c: 6.9% vs. 7.8% [52.1 vs. 61.8 mmol/mol], P < 0.001; planned pregnancy (88% vs. 59%, P < 0.001); taken folic acid preconception (81% vs. 43%, P = 0.001); and had HbA1c recorded preconception (88% vs. 53%, P < 0.001) than the pre-DVD cohort.

      Conclusions

      Implementation of a preconception counselling resource was associated with improved pregnancy planning indicators. Women with type 2 diabetes are difficult to reach. Greater awareness within primary care of the importance of preconception counselling among this population is needed.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Primary Care Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • CEMACH
        Pregnancy in Women with Type 1 and Type 2 Diabetes in 2002–2003,.
        Confidential Enquiry into Maternal and Child Health, England, Wales and Northern Ireland, London2005
        • Jensen D.M.
        • Damm P.
        • Moelsted-Pedersen L.
        • Ovesen P.
        • Westergaard J.G.
        • Moeller M.
        • Beck-Nielsen H.
        Outcomes in type 1 diabetic pregnancies: a nationwide, population-based study.
        Diabetes Care. 2004; 27: 2819-2823
        • Evers I.M.
        • de Valk H.W.
        • Visser G.H.
        Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands.
        BMJ. 2004; 328: 915
        • Hadden D.R.
        • Alexander A.
        • McCance D.R.
        • Traub A.I.
        • Northern Ireland Diabetes Group, Ulster Obstetrical Society
        Obstetric and diabetic care for pregnancy in diabetic women: 10 years outcome analysis, 1985–1995.
        Diabet. Med. 2001; 18: 546-553
        • Sibai B.M.
        • Caritis S.
        • Hauth J.
        • Lindheimer M.
        • VanDorsten J.P.
        • MacPherson C.
        • et al.
        Risks of preeclampsia and adverse neonatal outcomes among women with pregestational diabetes mellitus National Institute of Child Health and Human Development Network of Maternal–Fetal Medicine Units.
        Am. J. Obstet. Gynecol. 2000; 182: 364-369
        • Inkster M.E.
        • Fahey T.P.
        • Donnan P.T.
        • Leese G.P.
        • Mires G.J.
        • Murphy D.J.
        Poor glycated haemoglobin control and adverse pregnancy outcomes in type 1 and type 2 diabetes mellitus: systematic review of observational studies.
        BMC Pregnancy Childbirth. 2006; 6: 30
        • Pearson D.W.
        • Kernaghan D.
        • Lee R.
        • Penney G.C.
        • Scottish Diabetes in Pregnancy Study Group
        The relationship between pre-pregnancy care and early pregnancy loss, major congenital anomaly or perinatal death in type I diabetes mellitus.
        BJOG. 2007; 114: 104-107
        • Murphy H.R.
        • Roland J.M.
        • Skinner T.C.
        • Simmons D.
        • Gurnell E.
        • Morrish N.J.
        • et al.
        Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes: benefits beyond glycemic control.
        Diabetes Care. 2010; 33: 2514-2520
        • Ray J.G.
        • O’Brien T.E.
        • Chan W.S.
        Preconception care and the risk of congenital anomalies in the offspring of women with diabetes mellitus: a meta-analysis.
        QJM. 2001; 94: 435-444
        • Wahabi H.A.
        • Alzeidan R.A.
        • Bawazeer G.A.
        • Alansari L.A.
        • Esmaeil S.A.
        Preconception care for diabetic women for improving maternal and fetal outcomes: a systematic review and meta-analysis.
        BMC Pregnancy Childbirth. 2010; 10: 63
      1. National Institute for Clinical Excellence (NICE) (Great Britain): Diabetes in Pregnancy: Management from Preconception to the Postnatal Period. Available from: http://www.nice.org.uk/guidance/ng3 (accessed 20.01.15).

        • American Diabetes Association
        Standards of medical care in diabetes-2014.
        Diabetes Care. 2010; 37: S14-S80
        • Kim C.
        • Ferrara A.
        • McEwen L.N.
        • Marrero D.G.
        • Gerzoff R.B.
        • Herman W.H.
        • TRIAD Study Group
        Preconception care in managed care: the translating research into action for diabetes study.
        Am. J. Obstet. Gynecol. 2005; 192: 227-232
        • Varughese G.I.
        • Chowdhury S.R.
        • Warner D.P.
        • Barton D.M.
        Preconception care of women attending adult general diabetes clinics – are we doing enough?.
        Diabetes Res. Clin. Pract. 2007; 76: 142-145
        • Temple R.
        Preconception care for women with diabetes: is it effective and who should provide it?.
        Best. Pract. Res. Clin. Obstet. Gynaecol. 2011; 25: 3-14
        • Confidential Enquiry into Maternal and Child Health
        Diabetes in Pregnancy: Are we providing the best care? Findings of a National Enquiry.
        CEMACH, England, Wales and Northern Ireland, London2007
        • Spence M.
        • Alderdice F.A.
        • Harper R.
        • McCance D.R.
        • Holmes V.A.
        An exploration of knowledge and attitudes related to pre-pregnancy care in women with diabetes.
        Diabet. Med. 2010; 27: 1385-1391
        • McCorry N.K.
        • Hughes C.
        • Spence D.
        • Holmes V.A.
        • Harper R.
        Pregnancy planning and diabetes: a qualitative exploration of women's attitudes toward preconception care.
        J. Midwifery Womens Health. 2012; 57: 396-402
        • Spence M.
        • Harper R.
        • McCance D.R.
        • Alderdice F.
        • McKinley M.
        • Hughes C.
        • Holmes V.A.
        Women with diabetes: things you need to know (but maybe don’t!); the systematic development of an innovative DVD to raise awareness of preconception care.
        Eur. Diabetes Nurs. 2013; 12: 7-12
        • Holmes V.A.
        • Spence M.
        • McCance D.R.
        • Patterson C.C.
        • Harper R.
        • Alderdice F.A.
        Evaluation of a DVD for women with diabetes: impact on knowledge and attitudes to preconception care.
        Diabet. Med. 2012; 29: 950-956
        • Burns A.C.
        The expanded health belief model as a basis for enlightened preventive health care practice and research.
        J. Health Care Mark. 1992; 12: 32-45
      2. Northern Ireland Statistics Agency Multiple Deprivation Measure 2010. http://www.nisra.gov.uk/deprivation/nimdm_2010.htm (accessed 21.11.13).

        • McCance D.R.
        • Holmes V.A.
        • Maresh M.J.
        • Patterson C.C.
        • Walker J.D.
        • Pearson D.W.
        • Young I.S.
        • Diabetes and Pre-eclampsia Intervention Trial (DAPIT) Study Group
        Vitamins C and E for prevention of pre-eclampsia in women with type 1 diabetes (DAPIT): a randomised placebo-controlled trial.
        Lancet. 2010; 376: 259-266
        • Willhoite M.B.
        • Bennert Jr., H.W.
        • Palomaki G.E.
        • Zaremba M.M.
        • Herman W.H.
        • Williams J.R.
        • Spear N.H.
        The impact of preconception counseling on pregnancy outcomes. The experience of the Maine Diabetes in Pregnancy Program.
        Diabetes Care. 1993; 16: 450-455
        • Tripathi A.
        • Rankin J.
        • Aarvold J.
        • Chandler C.
        • Bell R.
        Preconception counselling in women with diabetes: a population-based study in the north of England.
        Diabetes Care. 2010; 33: 586-588
        • Charron-Prochownik D.
        • Ferons-Hannan M.
        • Sereika S.
        • Becker D.
        Randomized efficacy trial of early preconception counseling for diabetic teens (READY-girls).
        Diabetes Care. 2008; 31: 1327-1330
        • Roland J.M.
        • Murphy H.R.
        • Ball V.
        • Northcote-Wright J.
        • Temple R.C.
        The pregnancies of women with type 2 diabetes: poor outcomes but opportunities for improvement.
        Diabet. Med. 2005; 22: 1774-1777
        • Mortagy I.
        • Kielmann K.
        • Baldeweg S.E.
        • Modder J.
        • Pierce M.B.
        Integrating preconception care for women with diabetes into primary care: a qualitative study.
        Br. J. Gen. Pract. 2010; 60: 815-821
      3. Women with diabetes preconception counselling resource. www.womenwithdiabetes.net (accessed 20.01.16).