Preconception Counseling, Contraceptive Counseling, and Long-Acting Reversible Contraception Use in Women with Type I Diabetes: A Retrospective Cohort Study

Abstract

Background: Reproductive-age women with type I diabetes require preconception counseling, contraceptive counseling, and access to long-acting reversible contraception (LARC) to better support peri-conception glycemic control and decrease rates of unplanned pregnancies and adverse pregnancy outcomes. Materials and Methods: This retrospective cohort study identified women (16-49 years old) with an ICD-9/ICD-10 code for type I diabetes and documented hemoglobin A1c (HbA1c) level in a tertiary referral center between January 1, 2010 and October 30, 2017. We abstracted 2 years of data centered on the time of the highest recorded HbA1c. We identified preconception counseling, contraceptive counseling, LARC use, provider type, and the presence of advanced vascular complications or disease >20 years duration. Multivariable logistic regression related disease severity and provider type to counseling and LARC documentation when controlling for patient age and race. Results: Among 541 women, only 5% received preconception counseling, 25% received contraceptive counseling, and 13% used LARC. Younger age and more visits were associated with documented preconception or contraceptive counseling (p < 0.01). Maternal fetal medicine specialists most frequently documented preconception counseling (16%, p = 0.01), whereas gynecologists most frequently documented contraceptive counseling (73%, p < 0.01). Contraceptive counseling was highly associated with LARC use (adjusted odds ratio 9.87, 95% confidence interval 5.09-19.12). Conclusions: Reproductive-age women with type I diabetes have infrequent documentation of preconception counseling and contraceptive counseling. Educating primary care providers and endocrinologists could avoid missed opportunities to improve pregnancy planning and outcomes.

Family planning behaviours among women with diabetes mellitus: a scoping review

“…Six studies utilized secondary data from pre-existing survey database [ 25 , 37 , 44 , 46 , 51 ] where three of them were nationwide survey [ 25 , 44 , 51 ], two were state-wide [ 45 , 46 ] and one was combined from multiple states survey [ 37 ]. Five studies used insurance claim records [ 34 , 38 , 42 , 47 , 48 ], one study used a general practice database [ 57 ] and one study used a tertiary centre database [ 39 ]. Other studies were based on primary data collection.…”

“…Study populations varied where most of the studies ( n = 27) did not specify the types of diabetes mellitus while six studies were specifically among women with Type 1 diabetes mellitus in specialist centre [ 10 , 35 , 39 , 40 , 49 , 50 ] and three studies among Type 2 diabetes mellitus [ 43 , 52 , 60 ]. Nine studies reported diabetes mellitus with other selected medical conditions [ 37 , 38 , 45 , 46 , 51 , 54 , 60 , 65 , 66 ] and another six studies include all women within reproductive age group in the analysis [ 25 , 34 , 37 , 42 , 47 , 48 ].…”

“…Most of the studies described the usage of family planning practice by types of methods ( n = 26) [ 10 , 25 , 33 – 35 , 38 , 40 – 42 , 44 , 47 – 51 , 54 , 56 – 62 , 64 – 66 ] and eight studies categorized the methods according to level of effectiveness [ 25 , 41 , 46 , 48 , 50 , 53 , 56 , 62 ]. Only one study studied specifically the use of long-acting reversible contraception (LARC) among women with diabetes mellitus [ 39 ]. Five studies described the barriers of family planning usage or reasons of contraceptive non-use [ 33 , 41 , 52 , 58 , 65 ]; two of them through qualitative exploration [ 52 , 58 ].…”

Uptake of long-acting reversible contraceptives in north central Nigeria: a five-year review

“…Over the decades, family planning programs were principally driven by the development partners and nongovernmental organizations with external funding. 11,12,14 These efforts are commendable but may not augur well for sustainability in the long term if local authorities fail to assume ownership of these programs. Clients using LARC were largely educated, up to secondary level or more, this may also buttress the reason for the high uptake rate in this facility.…”

“…11,13 Studies in Africa have documented deep-seated resistance to the use of modern contraceptives. 11,12,14 The aim of this study is to determine the uptake of LARC in University of Abuja teaching hospital (UATH) and the characteristics of acceptors, complications and reasons for discontinuation.…”