RF16 | PSUN179 Providing Contraception and Preconception Counseling to Women with Diabetes: Health Care Provider Behaviors and Patient Perception
Authors: Rajiyah Tara , Dude Annie , Thomas Celeste 
Published: November 2022

Background

The Endocrine Society recommends preconception counseling be provided to all women with DM who are considering pregnancy; the ADA recommends counseling women of childbearing age with DM on the importance of tight pregnancy glycemic control and appropriate use of contraception at pubertal onset. However, only 25% of women receive contraception and preconception counseling (PCC). As most studies are retrospective chart reviews, what is cited may not reflect the PCC offered.

Methods

Physicians and advanced care providers (n=97) at one institution were surveyed on their behaviors in offering and documenting PCC provided to women with T1DM and T2DM.

Women with T1DM and T2DM (n=15) receiving care at the same institution were contacted after a recent endocrine visit and surveyed on the PCC they received. A retrospective chart review examined how the women's perception of the PCC provided correlated with documentation.

Additionally, similar surveys were distributed to women aged 18 to 50 via diabetes groups on a social media platform (n=202).

Results

Overall, 37% of providers reported offering PCC &lt; 5% of the time; PCPs and pediatric endocrinologists were least likely to offer PCC (p&lt;0.01 between all groups). The majority of OBGYNs and endocrinologists shared PCC up to 25% of the time (p &gt;0.05).

Providers were most likely to educate on or prescribe contraception. Half said they document counseling &gt;75% of the time.

Of all the women surveyed (n=217), 89% had T1DM, 91% were White and the average HbA1c was in the 6.6%-6.9% range. 59% of women reported previous pregnancies and 6.9% were pregnant. There was no difference in HbA1cs for those planning or considering pregnancy and those who were not (HbA1c 7% v 6.7%, p &gt;0.05 in chart review survey; HbA1c 6.6-6.9% in both groups in social media survey, p &gt;0.05).

55% reported receiving PCC in the past, most likely from their endocrinologist or OBGYN.

The most frequently reported forms of contraception were OCPs (22%) followed by barrier contraception (18%)–generally with other methods—followed by no form of contraception (15%).

In the chart review survey (n=15), none were currently pregnant but 13% were planning pregnancy in the next year and 47% were unsure of their plans. Two reported PCC was discussed at their most recent visit; one reported receiving PCC at the penultimate visit. Of these three visits, PCC was documented twice. Topics commonly discussed were glycemic targets, preconception planning, and contraception.

Conclusion

This study suggests the rates of lifetime PCC are higher than described and lower reported rates may be related to deficiencies in documentation. However, the small size of the chart review survey limits the ability to draw definitive conclusions. This study may also be limited by self-selection bias and over-representation of White patients among survey respondents.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Sunday, June 12, 2022 12:48 p.m. - 12:53 p.m.