Preconception care for women with type 2 diabetes mellitus

A mixed-methods study of provider knowledge and practice

Jan J. Klein, J.A. Boyle, R. Kirkham, Christine Connors, Cherie Whitbread, Jeremy J N Oats, F Barzi, D. McIntyre, I. Lee, M. Luey, J. Shaw, A. D.H. Brown, Louise J Maple-Brown

Research output: Contribution to journalArticleResearchpeer-review

6 Citations (Scopus)

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 - 1 Jul 2017

Keywords

  • Aboriginal health
  • Diabetes in pregnancy
  • Preconception care
  • Type 2 diabetes mellitus

Cite this

Klein, Jan J. ; Boyle, J.A. ; Kirkham, R. ; Connors, Christine ; Whitbread, Cherie ; Oats, Jeremy J N ; Barzi, F ; McIntyre, D. ; Lee, I. ; Luey, M. ; Shaw, J. ; Brown, A. D.H. ; Maple-Brown, Louise 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.
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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.",
keywords = "Aboriginal health, Diabetes in pregnancy, Preconception care, Type 2 diabetes mellitus",
author = "Klein, {Jan J.} and J.A. Boyle and R. Kirkham and Christine Connors and Cherie Whitbread and Oats, {Jeremy J N} and F Barzi and D. McIntyre and I. Lee and M. Luey and J. Shaw and Brown, {A. D.H.} and Maple-Brown, {Louise J}",
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Klein, JJ, Boyle, JA, Kirkham, R, Connors, C, Whitbread, C, Oats, JJN, Barzi, F, McIntyre, D, Lee, I, Luey, M, Shaw, J, Brown, ADH & Maple-Brown, LJ 2017, 'Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice', Diabetes Research and Clinical Practice, vol. 129, pp. 105-115. https://doi.org/10.1016/j.diabres.2017.03.035

Preconception care for women with type 2 diabetes mellitus : A mixed-methods study of provider knowledge and practice. / Klein, Jan J.; Boyle, J.A.; Kirkham, R.; Connors, Christine; Whitbread, Cherie; Oats, Jeremy J N; Barzi, F; McIntyre, D.; Lee, I.; Luey, M.; Shaw, J.; Brown, A. D.H.; Maple-Brown, Louise J.

In: Diabetes Research and Clinical Practice, Vol. 129, 01.07.2017, p. 105-115.

Research output: Contribution to journalArticleResearchpeer-review

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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

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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.

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