March 19, 2018
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Preconception counseling in women with diabetes lacking in primary care

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CHICAGO — Women of childbearing age with diabetes are often not receiving preconception counseling that is recommended by the American Diabetes Association, according to survey data presented at the Endocrine Society Annual Meeting.

Previous studies have demonstrated that preconception counseling is associated with a decrease in birth defects and other complications in the offspring of mothers with type 1 and type 2 diabetes, Angela L. Magdaleno, DO, medical resident with Lehigh Valley Health Network in Allentown, Pennsylvania, and colleagues noted in a poster presentation here. Yet, their survey of primary care physicians in obstetrics and gynecology, internal medicine and family medicine revealed that many providers did not regularly discuss the importance of blood glucose control or provide comprehensive preconception counseling.

“In our study, rates of preconception counseling among women of childbearing age with diabetes were very low,” Magdaleno said in a press release. “Primary care providers believed they were providing preconception counseling with patients more frequently than they actually were.”

In a review of electronic medical records, Magdaleno and colleagues analyzed data from 577 women aged 18 to 35 years with type 1 or type 2 diabetes with or without complications, who had at least one in-office visit over a 2-year period. Researchers reviewed office notes to determine whether the patients received preconception counseling, and sent anonymous surveys to 524 providers in the system inquiring about the preconception counseling services they provided to women with diabetes; 18.5% of providers responded.

Among all primary care providers, 39% believed they were providing preconception to women with diabetes counseling regularly, defined as more than 80% of the time. However, only 18.9% of such patients received preconception counseling during an office visit. Providers in obstetrics and gynecology were more likely to discuss preconception counseling with their patients vs. providers in internal medicine or family medicine, according to researchers (36.1% vs. 9.8% and 7.1%).

“Our survey has revealed the following perceived barriers to preconception counseling: providers’ lack of time, the perception that women should request preconception counseling and that pregnancies are unplanned,” Magdaleno said in the release. “Organizations providing health care to women of childbearing age with diabetes should develop processes to implement higher rates of preconception counseling. Based on our physician survey, primary care provider perceptions to barriers of counseling need to be addressed to improve rates of preconception discussions with women of childbearing age with diabetes.” – by Regina Schaffer

Reference:

Magdaleno AL, et al. SAT-724. Presented at: The Endocrine Society Annual Meeting; March 17-20, 2018; Chicago.

Disclosure: Magdaleno reports no relevant financial disclosures.