Diabetes and Pregnancy: Factors associated with seeking pre-conception care

Janz, Nancy K.; Herman, William H.; Becker, Mark P.; Charron‐Prochownik, Denise; Shayna, V L; Lesnick, Timothy G.; Jacober, Scott J.; Fachnie, J D; Kruger, Davida F.; Sanfield, Jeffery

doi:10.2337/diacare.18.2.157

Cited by 123 publications

(108 citation statements)

References 33 publications

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“…Several factors may promote preconception care, including higher educational level, higher incomes, regular employment, and encouragement from health care providers to avoid unplanned pregnancies (21). Diabetes care providers should be warned of the failure of preconception care in women with diabetes.…”

Section: Diabetes and Pregnancy Groupmentioning

confidence: 99%

French Multicentric Survey of Outcome of Pregnancy in Women With Pregestational Diabetes

Boulot¹,

Chabbert-Buffet²,

D’ercole³

et al. 2003

Diabetes Care

215

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OBJECTIVE -To evaluate perinatal outcome in pregnancies in women with type 1 and type 2 diabetes and the influence of preconception care 10 years after the St. Vincent's declaration. RESEARCH DESIGN AND METHODS-A cross-sectional study was conducted in 12 perinatal centers in France in 2000 -2001. The main investigated outcomes were perinatal mortality, major congenital malformations, and preterm delivery.RESULTS -Among 435 single pregnancies, 289 (66.4%) were from women with type 1 and 146 (33.6%) from women with type 2 diabetes. Perinatal mortality rate was 4.4% (0.7% national rate), severe congenital malformations rate was 4.1% (2.2% national rate), and preterm delivery rate was 38.2% (4.7% national rate). Preconception care was provided in 48.5% women with type 1 diabetes and in 24.0% women with type 2 diabetes. Women whose first trimester HbA 1c was Ͼ8% had higher rates of perinatal mortality (9.2 vs. 2.5%; odds ratio 3.9; 95% CI 1.5-9.7; P Ͻ 0.005), major congenital malformations (8.3 vs. 2.5%; 3.5; 1.3-8.9; P Ͻ 0.01), and preterm delivery (57.6 vs. 24.8%; 1.4; 1.1-1.7; P Ͻ 0.005) than those with first trimester HbA 1c Ͻ8%. These results are similar to those reported in France in 1986 -1988.CONCLUSIONS -Pregnancies in women with diabetes are still poorly planned and complicated by higher rates of perinatal mortality and major congenital malformations. Despite knowledge of the importance of intensified glycemic control before pregnancy, reaching the St. Vincent's target needs further implementation in France. Diabetes Care 26:2990 -2993, 2003I n 1989, representatives of the government health departments and patients' organizations from all of the European countries met with diabetes experts under the aegis of the Regional Offices of the World Health Organization and the International Diabetes Federation in St. Vincent, Italy, and identified goals to be achieved in the treatment of diabetes (1). One of the declared aims was that within 5 years, "pregnancy outcome of diabetic women should approximate that of the nondiabetic women." Previous studies have shown that such results may be obtained in women with type 1 diabetes by providing effective preconception care and intensive support to improve glycemic control before and during the whole pregnancy (2-5). However, this was achieved in selected populations and in specialized units. By contrast, several surveys done in nonselected, geographically based populations showed that the prognosis of pregnancy in women with type 1 diabetes remains poorer than that of the general population (6,7). Moreover, new issues have been raised by the increasing prevalence of type 2 diabetes in pregnancy (8). Particularly, type 2 diabetes often remains unrecognized, and the rate of perinatal mortality in women with type 2 diabetes may be higher than in those with type 1 diabetes (9).In 1986 -1988, a multicenter survey of pregnancies in women with diabetes was performed in France (10). It essentially showed that the rate of perinatal mortality was 1.9% in women with type 1 diabete...

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Section: Diabetes and Pregnancy Groupmentioning

confidence: 99%

French Multicentric Survey of Outcome of Pregnancy in Women With Pregestational Diabetes

Boulot¹,

Chabbert-Buffet²,

D’ercole³

et al. 2003

Diabetes Care

215

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“…Each dimension was a composite score (higher scores ϭ greater levels of the construct). Outcomes were assessed at baseline, immediately postintervention (post-test 1), and at 3-month follow-up (post-test 2) by paper-and-pencil selfadministered questionnaires (Cronbach's ␣ ϭ 0.65-0.83) based on a standard validated interview schedule (22)(23). Data were analyzed using descriptive statistics, group comparative analyses, and repeated-measures mixed-modeling methods (24).…”

Section: Methodsmentioning

confidence: 99%

Randomized Efficacy Trial of Early Preconception Counseling for Diabetic Teens (READY-Girls)

et al. 2008

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OBJECTIVE -To develop and assess the feasibility of an early preconception counseling program for adolescents called READY-Girls (Reproductive-health Education and Awareness of Diabetes in Youth for Girls).RESEARCH DESIGN AND METHODS -A total of 53 adolescent females with type 1 diabetes between 16 and 19.9 years of age were randomized into groups receiving a CD-ROM, a book, or standard care (control) and given one comprehensive session. Outcomes were assessed at baseline, immediately after, and at 3 months.RESULTS -Teens who received the CD and those who received the book demonstrated significant (P Յ 0.05) sustained improvement (over 3 months) in knowledge, perceived benefits of both receiving preconception counseling and using effective family planning, and perceived more support with reproductive health issues.CONCLUSIONS -Clinical feasibility of the program was demonstrated. Both the CD and the book appeared to be efficacious formats for the short term. Future studies should examine repeated boosters of a CD and a book, which are not meant to replace but rather to reinforce and supplement health professional education.

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“…128 However, less than 20% of women with type I and type II diabetes receive prepregnancy care. 129 Women who are planning to become pregnant should be counseled regarding the increased risks of pregnancy, the genetics of diabetes, the changes in lifestyle necessary (i.e., a personal commitment to diabetes care by the woman and family), and the possibility of hospitalization during pregnancy. Women not currently planning pregnancy require general information regarding the risks of pregnancy and the need for prepregnancy planning.…”

Section: Pregnancy and Preconception Counselingmentioning

confidence: 99%

Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus

et al. 1997

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PURPOSE:To summarize current knowledge of interventions that should improve the care of patients with type II diabetes mellitus. Interventions lie within the realms of prevention, screening, and treatment, all of which are focused on office practice. METHODS:Review of the literature by a multidisciplinary team involved in the care of patients with diabetes, followed by synthesis of the literature into a clinical care guideline. Literature was identified through consultation with experts and a focused MEDLINE search. MAIN RESULTS:An algorithm-based guideline for screening and treatment of the complications of diabetes was developed. The emphasis is on prevention of atherosclerotic disease, and prevention, screening, and early treatment of microvascular disease. Implementation of these practices has the potential to significantly improve quality of life and increase life expectancy in patients with type II diabetes mellitus. ype II diabetes is a common condition, affecting 2% to 3% of the adult population, and up to 20% to 25% of the elderly population. 1 Type II diabetes typically occurs in patients who are over 30 years old and weigh more than 120% of ideal body weight, and accounts for 90% of all cases of diabetes mellitus diagnosed in the United States. 1 Minorities have a prevalence of type II diabetes mellitus that is 2 to 6 times greater than that of white persons. The morbidity and mortality are higher for minorities than for white persons, and the rate is increasing. 2 The reasons for this disparity remain unclear, but could include differences in disease severity, comorbidities, or access to care.Diabetes has significant associated morbidity. Prevention and treatment of the complications of diabetes mellitus have the potential to improve quality of life and increase life expectancy. 3 The rate of cardiovascular disease is markedly elevated among patients with type II diabetes, leading to an increased mortality rate compared with the general population. 4,5 In addition, microvascular complications, which include retinopathy, nephropathy, and neuropathy, can progress to end-stage outcomes such as blindness, end-stage renal disease (ESRD), and amputation. Screening and early treatment for diabetic complications have been shown to be effective in reducing the incidence of end-stage disease 6,7 ; despite this evidence, implementation rates of recommended interventions are low. 8 This frequently leads to ineffective or delayed treatment of complications. 9-11 Because optimal diabetes care is a complex process, we developed a clinical care guideline to help busy clinicians incorporate prevention, screening, and treatment recommendations into practice. METHODSA multidisciplinary team was assembled to develop an evidence-based guideline for the prevention and treatment of complications of type II diabetes. The multidisciplinary team included members from endocrinology, family practice, general internal medicine, obstetrics-gyncecology, nursing, and postgraduate medicine departments. Team members have an interest ...

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Diabetes and Pregnancy: Factors associated with seeking pre-conception care

Cited by 123 publications

References 33 publications

French Multicentric Survey of Outcome of Pregnancy in Women With Pregestational Diabetes

French Multicentric Survey of Outcome of Pregnancy in Women With Pregestational Diabetes

Randomized Efficacy Trial of Early Preconception Counseling for Diabetic Teens (READY-Girls)

Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus

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