Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice

Klein, Jan J.; Boyle, Jacqueline; Kirkham, Renae; Connors, Christine; Whitbread, Cherie; Oats, Jeremy; Barzi, Federica; McIntyre, David; Lee, I.; Luey, Michele; Shaw, Jonathan E.; Brown, Alex; Maple-Brown, Louise

doi:10.1016/j.diabres.2017.03.035

Cited by 27 publications

(21 citation statements)

References 39 publications

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“…Information technology could also be used more effectively for recall systems. It was evident that many staff involved in pregnancy care were not involved in either pre-pregnancy or postnatal care beyond 6 weeks, or long-term follow-up screening, where an “inter-pregnancy” window to give opportunistic lifestyle and pre-conception counseling exists (22, 23). A need for more structured follow-up systems has been suggested by others (24).…”

Section: Discussionmentioning

confidence: 99%

Improving Models of Care for Diabetes in Pregnancy: Experience of Current Practice in Far North Queensland, Australia

McLean

Kirkham

Campbell

et al. 2019

Front. Public Health

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Aims: To map health practitioners' experiences and describe knowledge regarding screening and management of Diabetes in Pregnancy (DIP) in Far North Queensland, Australia. Methods: Mixed methods including a cross-sectional survey (101 respondents) and 8 focus groups with 61 health practitioners. All participants provided clinical care for women with DIP. Results: A wide range of healthcare professionals participated; 96% worked with Indigenous women, and 63% were from regional or remote work settings. Universal screening for gestational diabetes at 24–28 weeks gestation was reported as routine with 87% using a 75 g Oral Glucose Tolerance Test. Early screening for DIP was reported by 61% although there was large variation in screening methods and who should be screened <24 weeks. Health practitioners were confident providing lifestyle advice (88%), dietary, and blood glucose monitoring education (67%, 81%) but only 50% were confident giving insulin education. Electronic medical records were used by 80% but 55% also used paper records. Dissatisfaction with information from hospitals was reported by 40%. In the focus groups improving communication and information technology systems were identified as key areas. Other barriers described were difficulties in care coordination and access for remote women. Conclusions: Communication, information technology systems, coordination of care, and education for health professionals are key areas that will be addressed by a complex health systems intervention being undertaken by the DIP Partnership in North Queensland.

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Section: Discussionmentioning

confidence: 99%

Improving Models of Care for Diabetes in Pregnancy: Experience of Current Practice in Far North Queensland, Australia

McLean

Kirkham

Campbell

et al. 2019

Front. Public Health

View full text Add to dashboard Cite

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“…In light of the risks associated with hyperglycaemia in pregnancy, postpartum care is essential to addressing postpartum glycaemic status and the long-term risk for both women and their future children. Many women do not present for pre-conception care [12,13] and, hence, the postpartum (or 'inter-pregnancy') period may be the only time for opportunistic health messaging prior to future pregnancies. It is an ideal time to support women to reduce their risk of developing T2D and recurrent GDM, or to optimally manage their T2D and other cardiovascular risk factors, with benefits for both women and their future children [14].…”

Section: Introductionmentioning

confidence: 99%

Primary Health Care for Aboriginal Australian Women in Remote Communities after a Pregnancy with Hyperglycaemia

Wood

MacKay

Fitzsimmons

et al. 2020

IJERPH

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Background: Hyperglycaemia in pregnancy contributes to adverse outcomes for women and their children. The postpartum period is an opportune time to support women to reduce cardiometabolic and diabetes risk in subsequent pregnancies. Aims: To identify strengths and gaps in current care for Aboriginal women after a pregnancy complicated by hyperglycaemia. Methods: A retrospective review of the 12 month postpartum care provided by primary health centres in remote Australia in 2013-2014 identified 195 women who experienced hyperglycaemia in pregnancy (gestational diabetes (GDM) (n = 147), type 2 diabetes (T2D) (n = 39), and unclear diabetes status (n = 9)). Results: Only 80 women (54%) with GDM had postpartum glycaemic checks. Of these, 32 women were diagnosed with prediabetes (n = 24) or diabetes (n = 8). Compared to women with GDM, women with T2D were more likely to have their weight measured (75% vs. 52%, p <0.01), and smoking status documented as "discussed" (65% vs. 34%, p < 0.01). Most women (97%) accessed the health centre at least once in the 12 month postpartum period but, during these visits, only 52% of women had service provision, either structured or opportunistic, related to diabetes. Conclusion: High rates of dysglycaemia among women screened for T2D after GDM in the 12 month postpartum period highlight the need for increased screening and early intervention to prevent the development of T2D and its complications. Whilst a clear strength was high postpartum attendance, many women did not attend health services for diabetes screening or management.

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“…Most women with type 2 diabetes have routine care in primary care settings, where awareness of the specific issues of diabetes pregnancy preparation is limited [ 8 , 12 ]. This leads to low levels of awareness regarding the importance of safe, effective contraception to avoid an unintended pregnancy and of PPC in women who are thinking about trying for a baby.…”

Section: Introductionmentioning

confidence: 99%

“…This leads to low levels of awareness regarding the importance of safe, effective contraception to avoid an unintended pregnancy and of PPC in women who are thinking about trying for a baby. Women with type 2 diabetes are more likely to live in areas of socioeconomic deprivation and belong to ethnic minority groups so may have additional financial, cultural and ethnic barriers to accessing healthcare [ 8 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Community-based pre-pregnancy care programme improves pregnancy preparation in women with pregestational diabetes

et al. 2018

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Aims/hypothesis Women with diabetes remain at increased risk of adverse pregnancy outcomes associated with poor pregnancy preparation. However, women with type 2 diabetes are less aware of and less likely to access pre-pregnancy care (PPC) compared with women with type 1 diabetes. We developed and evaluated a community-based PPC programme with the aim of improving pregnancy preparation in all women with pregestational diabetes. Methods This was a prospective cohort study comparing pregnancy preparation measures before and during/after the PPC intervention in women with pre-existing diabetes from 1 June 2013 to 28 February 2017. The setting was 422 primary care practices and ten National Health Service specialist antenatal diabetes clinics. A multifaceted approach was taken to engage women with diabetes and community healthcare teams. This included identifying and sending PPC information leaflets to all eligible women, electronic preconception care templates, online education modules and resources, and regional meetings and educational events. Key outcomes were preconception folic acid supplementation, maternal HbA 1c level, use of potentially harmful medications at conception and gestational age at first presentation, before and during/after the PPC programme. Results A total of 306 (73%) primary care practices actively participated in the PPC programme. Primary care databases were used to identify 5075 women with diabetes aged 18-45 years. PPC leaflets were provided to 4558 (89.8%) eligible women. There were 842 consecutive pregnancies in women with diabetes: 502 before and 340 during/after the PPC intervention. During/after the PPC intervention, pregnant women with type 2 diabetes were more likely to achieve target HbA 1c levels ≤48 mmol/mol (6.5%) (44.4% of women before vs 58.5% of women during/after PPC intervention; p = 0.016) and to take 5 mg folic acid daily (23.5% and 41.8%; p = 0.001). There was an almost threefold improvement in 'optimal' pregnancy preparation in women with type 2 diabetes (5.8% and 15.1%; p = 0.021). Women with type 1 diabetes presented for earlier antenatal care during/after PPC (54.0% vs 67.3% before 8 weeks' gestation; p = 0.003) with no other changes. Conclusions/interpretation A pragmatic community-based PPC programme was associated with clinically relevant improvements in pregnancy preparation in women with type 2 diabetes. To our knowledge, this is the first community-based PPC intervention to improve pregnancy preparation for women with type 2 diabetes. Data availability Further details of the data collection methodology, individual clinic data and the full audit reports for healthcare professionals and service users are available from https://digital.nhs.uk/data-and-information/clinical-audits-and-registries/ourclinical-audits-and-registries/national-pregnancy-in-diabetes-audit.

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Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice

Cited by 27 publications

References 39 publications

Improving Models of Care for Diabetes in Pregnancy: Experience of Current Practice in Far North Queensland, Australia

Improving Models of Care for Diabetes in Pregnancy: Experience of Current Practice in Far North Queensland, Australia

Primary Health Care for Aboriginal Australian Women in Remote Communities after a Pregnancy with Hyperglycaemia

Community-based pre-pregnancy care programme improves pregnancy preparation in women with pregestational diabetes

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