How Are We Doing? Documentation of Preconception and Contraceptive Counseling and LARC Use in Type I Diabetic Women [2N]

Abstract

INTRODUCTION: To explore the frequency of preconception and contraceptive counseling and LARC use in type I diabetic women. METHODS: This retrospective cohort study identified women (16-49 years-old) with an ICD-9/ICD-10 code for type I diabetes and documented A1C level in a tertiary referral center between 1/1/2010-10/30/2017. We abstracted preconception or contraceptive counseling and LARC documentation within 1 year pre- and post-highest A1C. We identified provider type: primary care (PCP), endocrinology, obstetrics/gynecology (OB/GYN), and maternal fetal medicine (MFM). We defined advanced disease by micro- or macro-vascular complications or disease >20 years. Multivariable logistic regression related disease severity and provider type to counseling and LARC documentation when controlling for age and race. RESULTS: We included 541 women. Median age was 30.7 (range 17-49), A1C was 9.1% (5%-20%), and median 4 visits (range 1-38) during the two-year span. Only 5% received preconception counseling, 25% received contraceptive counseling, and 13% used LARC. MFMs most frequently documented preconception counseling (16%, P=0.01), while OB/GYNs most frequently documented contraceptive counseling (73%, P<0.01). LARC documentation was higher in MFM (26%) and OB/GYN (27%) visits compared to endocrinology (10%) and PCP (11%) visits (all P<0.01). Advanced disease resulted in less preconception counseling (3%, P=0.05), yet similar contraceptive counseling frequency and LARC use compared to non-advanced disease. Contraceptive counseling was highly associated with LARC use (aOR 9.87, 95% CI 5.09-19.12). CONCLUSION: Reproductive age type I diabetic women have high healthcare utilization, yet documentation of preconception and contraceptive counseling is sparse. Educating non-OB/GYN providers could avoid missed opportunities to improve pregnancy planning and outcomes.