The Quality of Periconception Medical Care in Women With Diabetes Needs Improvement

Abstract

OBJECTIVEWe evaluated the quality of periconception medical care in pregnant women with diabetes and assessed the influence of sociodemographic characteristics. RESEARCH DESIGN AND METHODSThe study was based on retrospective data collection from electronic database on cohort of Israeli women at Clalit Health Services (CHS) with pre-existing diabetes who gave birth in 2008-2011. It included data on A1C and other laboratory test results, prescription fillings, diet and ophthalmology consultations, and sociodemographics extracted from CHS computerized systems. The performance of each of nine recommended measures in the periconception period and a composite quality score was evaluated; the score ranged from 0-8. Multivariate logistic regression was used to examine independent sociodemographic predictors of lowquality overall scores. RESULTSA total of 166 women gave birth to 180 infants; the performance of the different quality parameters ranged from 81% for A1C and kidney function tests to only 30% for dietary consultation and 41.1% for ophthalmology exam. Forty-nine percent of women had A1C <7.0% (53 mmol/mol). Only 45% took folic acid, whereas 13.9% continued the use of potentially teratogenic drugs in the first trimester. One-third of women were in the low-quality (0-3) overall score. In the multiple logistic regression analysis, the only significant variables to predict lower composite quality scores were multiparity odds ratio of 3.43 (95% CI 1.66-7.10; P = 0.001), Arabian ethnicity 3.76 (1.78-7.92; P = 0.001), and immigrant 3.73 (1.25-11.16; P = 0.018). CONCLUSIONSThe periconception medical care of diabetic women is suboptimal. More intensive and targeted care is needed in order to optimize periconception care of diabetic patients, especially in the high-risk subpopulations.

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

“…While there are a number of studies examining general preconception care from the practitioner perspective both internationally [26] and within Australia [27], these do not focus on care for women with pre-existing type 2 diabetes or Aboriginal women. Consistent with our findings of low rates of preconception care among Aboriginal women, existing evidence has identified that uptake of preconception care among women with T2DM was less likely in women from minority ethnicities and socioeconomic deprivation [28][29][30].…”

“…The higher recommended dose of folic acid was prescribed by 40% of practitioners in this study. Other studies assessing preconception folate in women with pre-existing diabetes report 45% of women had folate supplementation of any dose [29,30].…”

The viewpoints of managers and healthcare providers on individual barriers to perform preconception care for diabetic women

“…Despite the apparent effect of this process on the outcome of pregnancy of diabetic women, presenting and receiving this care still faces challenges. [ 6 ],[ 7 ],[ 8 ] Given that specific situation of diabetic women, PCC for diabetic women is more complicated than nondiabetic and requires more time, cost, and professional consultation on cardiovascular, renal, retinal and drug use, family planning, etc. [ 1 ] Therefore, diabetic women face more and more challenges than nondiabetics in receiving PCC.…”

“…[ 7 ],[ 10 ],[ 11 ] The lack of involvement of spouses in this process, the inadequacy of services provided in health centers, the lack of awareness of these women about the PCC process, and problems related to caring for the other child are among the individual barriers mentioned in various studies. [ 8 ],[ 10 ] Most of these studies are qualitative researches and have noted some of the obstacles in general, while the rank of barriers in terms of importance has not been determined. On the contrary, generalizability is not possible in qualitative studies.…”

“…Several studies have examined the views of service recipients. [ 5 ],[ 6 ],[ 8 ] Therefore, in this study, to reduce the bias and increase credibility and reliability of findings, the viewpoints of three groups of service providers (physicians, midwives, and health managers), who directly interacted with recipients, were examined so that the same view increases the credibility of the findings. Therefore, the present study was designed and implemented with the aim to evaluate the rank of individual barriers to PCC in terms of importance among diabetic women from the viewpoints of service providers.…”