Pregnancy planning in women with pregestational diabetes

Abstract

Objectives. Women with pregestational diabetes are advised to plan their pregnancies to optimize glycemia and reduce fetal complications. We evaluated the adequacy of pregnancy planning effort and medical planning in pregnant women with type 1 and type 2 diabetes.

Methods. This retrospective cohort study surveyed pregnant women with pregestational diabetes mellitus between 2006 and 2008 in Ontario, Canada. We evaluated three measures of pregnancy planning: pregnancy planning effort, medical planning based on prepregnancy glycemic control, and folic acid use. We compared women with type 1 and type 2 diabetes and explored predictors of pregnancy planning.

Results. Of the 163 women studied (89 type 1, 74 type 2 diabetes), 47% reported high pregnancy planning effort, 58% reported attempts to optimize glycemic control, and 56% took folic acid before pregnancy. Of those who reported high pregnancy planning, 20% did not medically plan their pregnancies. Rates were similar between women with type 1 and type 2 diabetes. The most important predictor of pregnancy planning was having discussed plans with their physician.

Conclusions. Our findings suggest that pregnancy planning is suboptimal in women with both type 1 and type 2 diabetes, highlighting a need to improve preconception counseling for all women with pregestational diabetes.

Keywords:

• Pregnancy planning
• diabetes
• survey study
• glycemic control
• pregnancy counseling

Acknowledgements

The authors would like to thank Beth Gherson, RN and Mary-Jane Martin, RN for recruitment of patients, administration of the questionnaire, chart review, and data entry; Pierina Cheung, BSc, for study co-ordination and data entry; and Vladana Urosevic for help with manuscript preparation. This study was funded by a Grant-in-Aid from the Canadian Diabetes Association (AR2051819LL). Dr. Lipscombe is supported by a Canadian Diabetes Association/Canadian Institute of Health Research (CDA/CIHR) Clinician Scientist award.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.