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

Klein, J., Boyle, J. A., Kirkham, R., Connors, C., Whitbread, C., Oats, J., Barzi, F., McIntyre, D., Lee, I., Luey, M., Shaw, J., Brown, A. D. H. and Maple-Brown, L. J. (2017) Preconception care for women with type 2 diabetes mellitus: a mixed-methods study of provider knowledge and practice. Diabetes Research and Clinical Practice, 129 105-115. doi:10.1016/j.diabres.2017.03.035

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Author Klein, J.
Boyle, J. A.
Kirkham, R.
Connors, C.
Whitbread, C.
Oats, J.
Barzi, F.
McIntyre, D.
Lee, I.
Luey, M.
Shaw, J.
Brown, A. D. H.
Maple-Brown, L. J.
Title Preconception care for women with type 2 diabetes mellitus: a mixed-methods study of provider knowledge and practice
Journal name Diabetes Research and Clinical Practice   Check publisher's open access policy
ISSN 1872-8227
Publication date 2017-07-01
Sub-type Article (original research)
DOI 10.1016/j.diabres.2017.03.035
Open Access Status Not yet assessed
Volume 129
Start page 105
End page 115
Total pages 11
Place of publication E Park, Shannon, Clare Ireland
Publisher Elsevier Ireland
Language eng
Subject 2724 Internal Medicine
2712 Endocrinology, Diabetes and Metabolism
1310 Endocrinology
Abstract Aims Preconception care may decrease adverse pregnancy outcomes associated with pre-existing diabetes mellitus. Aboriginal Australians are at high risk of type 2 diabetes mellitus (T2DM), with earlier onset. We explored practitioner views on preconception care delivery for women with T2DM in the Northern Territory, where 31% of births are to Aboriginal women. Methods Mixed-methods study including cross-sectional survey of 156 health practitioners and 11 semi-structured interviews. Results Practitioners reported low attendance for preconception care however, 51% provided counselling on an opportunistic basis. Rural/remote practitioners were most likely to find counselling feasible. The majority (69%) utilised appropriate guidelines and addressed lifestyle modifications including smoking (81%), weight management (79%), and change medications appropriately such as ceasing ACE inhibitors (69%). Fewer (40%) prescribed the recommended dose of folate (5 mg) or felt comfortable recommending delaying pregnancy to achieve optimal preconception glucose control (42%). Themes identified as barriers to care included the complexity of care setting and infrequent preconception consultations. There was a focus on motivation of women to make informed choices about conception, including birth spacing, timing and contraception. Preconception care enablers included cross-cultural communication, a multi-disciplinary care team and strong client-based relationships. Conclusions Health practitioners are keen to provide preconception counselling and reported knowledge of evidence-based guidelines. Improvements are needed in recommending high dose folate and optimising glucose control. Cross-cultural communication and team-based care were reported as fundamental to successful preconception care in women with T2DM. Continued education and policy changes are required to support practitioners in opportunities to enhance pregnancy planning.
Formatted abstract
Aims: Preconception care may decrease adverse pregnancy outcomes associated with pre-existing diabetes mellitus. Aboriginal Australians are at high risk of type 2 diabetes mellitus (T2DM), with earlier onset. We explored practitioner views on preconception care delivery for women with T2DM in the Northern Territory, where 31% of births are to Aboriginal women.

Methods: Mixed-methods study including cross-sectional survey of 156 health practitioners and 11 semi-structured interviews.

Results: Practitioners reported low attendance for preconception care however, 51% provided counselling on an opportunistic basis. Rural/remote practitioners were most likely to find counselling feasible. The majority (69%) utilised appropriate guidelines and addressed lifestyle modifications including smoking (81%), weight management (79%), and change medications appropriately such as ceasing ACE inhibitors (69%). Fewer (40%) prescribed the recommended dose of folate (5 mg) or felt comfortable recommending delaying pregnancy to achieve optimal preconception glucose control (42%). Themes identified as barriers to care included the complexity of care setting and infrequent preconception consultations. There was a focus on motivation of women to make informed choices about conception, including birth spacing, timing and contraception. Preconception care enablers included cross-cultural communication, a multi-disciplinary care team and strong client-based relationships.

Conclusions: Health practitioners are keen to provide preconception counselling and reported knowledge of evidence-based guidelines. Improvements are needed in recommending high dose folate and optimising glucose control. Cross-cultural communication and team-based care were reported as fundamental to successful preconception care in women with T2DM. Continued education and policy changes are required to support practitioners in opportunities to enhance pregnancy planning.
Keyword Aboriginal health
Diabetes in pregnancy
Preconception care
Type 2 diabetes mellitus
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID 631974
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
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