Preconception care for women with type 2 diabetes mellitus

A mixed-methods study of provider knowledge and practice

C J Klein, J. A. Boyle, R. Kirkham, C CONNORS, C. Whitbread, Jeremy J N Oats, F. Barzi, D McIntyre, I. Lee, M. Luey, Jonathan Shaw, Alex Brown, L. J. Maple-Brown

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    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.

    Original languageEnglish
    Pages (from-to)105-115
    Number of pages11
    JournalDiabetes Research and Clinical Practice
    Volume129
    DOIs
    Publication statusPublished - Jul 2017

    Fingerprint

    Preconception Care
    Type 2 Diabetes Mellitus
    Counseling
    Folic Acid
    Communication
    Northern Territory
    Guidelines
    Birth Intervals
    Glucose
    Pregnancy
    Health
    Pregnancy Outcome
    Contraception
    Angiotensin-Converting Enzyme Inhibitors
    Life Style
    Motivation
    Diabetes Mellitus
    Referral and Consultation
    Cross-Sectional Studies
    Smoking

    Cite this

    Klein, C J ; Boyle, J. A. ; Kirkham, R. ; CONNORS, C ; Whitbread, C. ; Oats, Jeremy J N ; Barzi, F. ; McIntyre, D ; Lee, I. ; Luey, M. ; Shaw, Jonathan ; Brown, Alex ; Maple-Brown, L. J. / Preconception care for women with type 2 diabetes mellitus : A mixed-methods study of provider knowledge and practice. In: Diabetes Research and Clinical Practice. 2017 ; Vol. 129. pp. 105-115.
    @article{5ee2f2b38e4e48378a006e24ce3cef14,
    title = "Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice",
    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.",
    keywords = "Aboriginal health, Diabetes in pregnancy, Preconception care, Type 2 diabetes mellitus",
    author = "Klein, {C J} and Boyle, {J. A.} and R. Kirkham and C CONNORS and C. Whitbread and Oats, {Jeremy J N} and F. Barzi and D McIntyre and I. Lee and M. Luey and Jonathan Shaw and Alex Brown and Maple-Brown, {L. J.}",
    year = "2017",
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    Preconception care for women with type 2 diabetes mellitus : A mixed-methods study of provider knowledge and practice. / Klein, C J; Boyle, J. A.; Kirkham, R.; CONNORS, C; Whitbread, C.; Oats, Jeremy J N; Barzi, F.; McIntyre, D; Lee, I.; Luey, M.; Shaw, Jonathan; Brown, Alex; Maple-Brown, L. J.

    In: Diabetes Research and Clinical Practice, Vol. 129, 07.2017, p. 105-115.

    Research output: Contribution to journalArticleResearchpeer-review

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    T1 - Preconception care for women with type 2 diabetes mellitus

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    AU - Klein, C J

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    AU - Kirkham, R.

    AU - CONNORS, C

    AU - Whitbread, C.

    AU - Oats, Jeremy J N

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    AU - McIntyre, D

    AU - Lee, I.

    AU - Luey, M.

    AU - Shaw, Jonathan

    AU - Brown, Alex

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    N2 - 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.

    AB - 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.

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