Barriers to Preconception Planning Among Health Care Professionals Who Treat Women with Diabetes

Objective:To describe results of a University of Utah College of Nursing study on barriers to preconception counseling among health providers treating women with diabetes

Methods: Women of reproductive age who have diabetes prior to pregnancy are at risk for pregnancy-induced hypertension, pre-eclampsia, and polyhydramnios. Developing fetuses are at increased risk for congenital anomalies, pre-term delivery, or death. The damage is thought to occur due to hyperglycemia during organogenesis in the earliest weeks of pregnancy. Unfortunately, 60% of pregnancies are unplanned and unexpected. Preconception counseling, wherein women are advised of the importance of glycemic control before conception, is often overlooked as part of comprehensive diabetes care. The American Diabetes Association recommends preconception counseling be offered to women of childbearing age at each routine visit. In September, 2009, an online survey was sent to more than 100 health care professionals to assess the extent of such counseling and barriers to its delivery.

Results: Over one-third (36.2%) of respondents reported they did not provide preconception counseling (n=69). The most commonly stated barriers were lack of patient education materials and lack of reminder prompts (24.6%, each). Findings were used to develop educational brochures for patients. Recommendations involved addition of charting prompts for documentation of preconception counseling.

Conclusion: Preconception counseling increases the chances of a healthy pregnancy outcome, yet few women with diabetes are receiving it.  Efforts to understand and address the barriers and encourage its consistent implementation will lead to fewer fetal deaths and improved pregnancy outcomes among mothers with diabetes.