TY - JOUR
T1 - Preconception care for women with type 2 diabetes mellitus
T2 - A mixed-methods study of provider knowledge and practice
AU - Klein, Jan J.
AU - Boyle, J.A.
AU - Kirkham, R.
AU - Connors, Christine
AU - Whitbread, Cherie
AU - Oats, Jeremy J N
AU - Barzi, F
AU - McIntyre, D.
AU - Lee, I.
AU - Luey, M.
AU - Shaw, J.
AU - Brown, A. D.H.
AU - Maple-Brown, Louise J
PY - 2017/7/1
Y1 - 2017/7/1
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.
KW - Aboriginal health
KW - Diabetes in pregnancy
KW - Preconception care
KW - Type 2 diabetes mellitus
UR - http://www.scopus.com/inward/record.url?scp=85019222660&partnerID=8YFLogxK
U2 - 10.1016/j.diabres.2017.03.035
DO - 10.1016/j.diabres.2017.03.035
M3 - Article
AN - SCOPUS:85019222660
SN - 0168-8227
VL - 129
SP - 105
EP - 115
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
ER -