Abstract :

Background: Women with diabetes have more complications during pregnancy. Contraceptive advice to prevent unplanned pregnancy is of utmost importance for them. Maintenance of strict glycaemic control is essential to have a positive outcome in pregnancy and proper care. Preconception care and counselling to help pregnancy planning is thus essential.

Aim: To assess whether proper education regarding importance of contraceptive use, preconception care and advice is being imparted to female diabetics according to NICE guidelines

Method: This is a proposed monocentric retrospective clinical audit to evaluate adherence of a diabetes clinic to NICE guidelines regarding education and advice on contraceptive use and preconception care. The three criteria being assessed include documentation of patient’s intentions regarding contraceptive use and pregnancy at each visit with the diabetes care team; offering patients intending to get pregnant a structured education programme as soon as possible; and preconception care and advice being imparted to patients wanting to try for pregnancy before discontinuing contraception. Two patient cohorts, each consisting of 50 patients who meet the inclusion and exclusion parameters for the respective criteria will be made. Data collection will be done by the diabetologist, the diabetes specialist nurse and the practice nurse at St. June’s Diabetes Clinic. Data will be collected by accessing previous records of patients from 01 January 2021 to 31 December 2021. Data will be compiled as a percentage and compared with the standard.

Conclusion: Improved patient-staff communication is the key point to improve compliance with NICE guidelines regarding these standards.

---

Keywords :

Contraception, Education, Maternal Diabetes, Preconception Care

---

References :

1. Andrea, F., William, H., & Susan, M. (2010). Impact of a Preconception Counseling Program for Teens With Type 1 …
2. Barral, R. L., Cartujano, B., Perales, J., Ramirez, M., Cowden, J. D., Trent, M. E., … Kessler, S. F. (2020). Knowledge, Beliefs, and Attitudes About Contraception Among Rural Latino Adolescents and Young Adults. Journal of Rural Health, 36(1), 38–47. https://doi.org/10.1111/jrh.12390
3. Britton, L. E., Hussey, J. M., Berry, D. C., Crandell, J. L., Brooks, J. L., & Bryant, A. G. (2019). Contraceptive Use Among Women with Prediabetes and Diabetes in a US National Sample. Journal of Midwifery and Women’s Health, 64(1), 36–45. https://doi.org/10.1111/jmwh.12936
4. Charron-Prochownik, D., Sereika, S. M., Becker, D., White, N. H., Schmitt, P., Blair Powell, A., … Downs, J. (2013). Long-term effects of the booster-enhanced READY-girls preconception counseling program on intentions and behaviors for family planning in teens with diabetes. Diabetes Care, 36(12), 3870–3874. https://doi.org/10.2337/dc13-0355
5. Hawthorne, G. (2011). Maternal complications in diabetic pregnancy. Best Practice and Research: Clinical Obstetrics and Gynaecology. https://doi.org/10.1016/j.bpobgyn.2010.10.015
6. Howarth, C., Gazis, A., & James, D. (2007). Associations of Type 1 diabetes mellitus, maternal vascular disease and complications of pregnancy. Diabetic Medicine, 24(11), 1229–1234. https://doi.org/10.1111/j.1464-5491.2007.02254.x
7. Kragelund Nielsen, K., Nielsen, S. M., Butler, R., & Lazarus, J. V. (2012). Key barriers to the use of modern contraceptives among women in Albania: a qualitative study . Reproductive Health Matters U6  – Ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.Serialssolutions.Com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.Genre=article&rft.Atitle=Key+barriers+to+the+use+of+modern+contr, Vol. 20, p. 158. Retrieved from http://chester.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV1di9QwFA2uogiy6Kzfq9wnX6TStEk3EXxYZJeV1QfZXQURlqRJYGDaGcaZB_313uS20-6Aiz74UkpCh6H35DYf557DWFm8ybOtnFArn0ulpOKIkFIL73JljRNOe8-diMXJ307U11P15XM8mekd54a2_xp4bMPQx0Lafwj-5kexAe8RAnhFEOD1r2BwimP
8. Lapolla, A., Dalfrà, M. G., Di Cianni, G., Bonomo, M., Parretti, E., & Mello, G. (2008). A multicenter Italian study on pregnancy outcome in women with diabetes. Nutrition, Metabolism and Cardiovascular Diseases, 18(4), 291–297. https://doi.org/10.1016/j.numecd.2006.12.001
9. Lowson, K., Jenks, M., Filby, A., Carr, L., Campbell, B., & Powell, J. (2015). Examining the implementation of NICE guidance: Cross-sectional survey of the use of NICE interventional procedures guidance by NHS Trusts. Implementation Science, 10(1), 1–10. https://doi.org/10.1186/s13012-015-0283-4
10. McCarthy, B., Fitzgerald, S., O’Shea, M., Condon, C., Hartnett-Collins, G., Clancy, M., … Savage, E. (2019). Electronic nursing documentation interventions to promote or improve patient safety and quality care: A systematic review. Journal of Nursing Management, 27(3), 491–501. https://doi.org/10.1111/jonm.12727
11. Mekonnen, T. T., Woldeyohannes, S. M., & Yigzaw, T. (2015). C ontraceptive use in women with hypertension and diabetes: Cross-sectional study in northwest Ethiopia. International Journal of Women’s Health, 7, 957–964. https://doi.org/10.2147/IJWH.S90741
12. (2015). National Institute for Health and Care Excellence (2015): Diabetes in pregnancy: management from preconception to the postnatal period (NG3). NICE Guideline [NG3], 63(2008), 42.
13. Nojomi, M., Morrovatdar, N., Davoudi, F., & Hosseini, S. (2013). Contraceptive use by Iranian women with hypertension, diabetes or obesity. In Eastern Mediterranean Health Journal (Vol. 19).
14. Pisani, I., Tiralongo, G., Lo Presti, D., Farsetti, D., Gagliardi, G., Vasapollo, B., … Valensise, H. (2019). OC28.06: Pregnancy complicated by type 1 diabetes, type 2 diabetes and gestational diabetes: maternal hemodynamic assessment and subsequent complications. Ultrasound in Obstetrics & Gynecology, 54(S1), 74–74. https://doi.org/10.1002/uog.20623
15. Schwarz, E. B., Postlethwaite, D., Hung, Y. Y., Lantzman, E., Armstrong, M. A., & Horberg, M. A. (2012). Provision of contraceptive services to women with diabetes mellitus. Journal of General Internal Medicine, 27(2), 196–201. https://doi.org/10.1007/s11606-011-1875-6
16. Tennant, P. W. G., Glinianaia, S. V., Bilous, R. W., Rankin, J., & Bell, R. (2014). Pre-existing diabetes, maternal glycated haemoglobin, and the risks of fetal and infant death: A population-based study. Diabetologia, 57(2), 285–294. https://doi.org/10.1007/s00125-013-3108-5
17. Tripathi, A., Rankin, J., Aarvold, J., Chandler, C., & Bell, R. (2010). Preconception counseling in women with diabetes: A population-based study in the north of England. Diabetes Care, 33(3), 586–588. https://doi.org/10.2337/dc09-1585
18. Vijayan, S., Antony, B. F. C., & Geeta, M. G. (2017). Cardiovascular morbidity of infants of diabetic mothers and its association with maternal glycaemic control according to HbA1c. Journal of Evolution of Medical and Dental Sciences, 6(49).
19. Wender-Ozegowska, E., Gutaj, P., Szczepanek, U., Ozegowska, K., Zawiejska, A., & Brazert, J. (2010). Influence of pregnancy planning on obstetrical results in women with pregestational diabetes mellitus . Ginekologia Polska , Vol. 81, p. 762. Retrieved from http://chester.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV1La9wwEBZNoKWX0ve76A-4-CEp1qGHUtqkhFJKNi30EmRpHNLs2suulyX-9R091wkU2kMvxkhIGH_jbx4azxBSlW_z7AYntKVWmqMtzqpaqEJJoXhpOHAjoM4b-3Pyz6P6x3H9_Zs9mYmZRLux_wo8jiH09kfafwA_bYoDeI8igFcUArz-lRh8jk1IXGr