Experiences of Preconception Counseling among Pregnant Women with Preexisting Diabetes: Opportunities to Improve Patient-Centered Care
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Theme 1: No Standard Version of Counseling
“I’m very glad that we had that opportunity, but I definitely had to seek it out. That [counseling] wasn’t necessarily going to be offered to me.”(Participant S)
“I went to a clinic regarding my diabetes and they asked me if I wanted to get pregnant. I told them ‘Yes’ ... and they told me that I should wait until I get my sugar under control.”(Participant T)
3.2. Theme 2: Information Provided during Counseling Typically Focuses on the Risk of Diabetes and Pregnancy
“I felt like the focus was a lot [of] talking about the risks and all of the challenges.”(Participant N)
“… they tell you, ‘Oh, you have high risk of literally everything. This is just a high-risk type situation.’ So naturally I was devastated because you never think about these things.”(Participant N)
3.3. Theme 3: Patients Seeking Counseling Felt Their Providers Were Generally Supportive of Their Pregnancy Desires, Although There Were a Few Exceptions
“... they did a really good job of just explaining what it all meant and she was saying, ‘In my experience, you’re not going to have perfect blood sugars and that’s okay.’”(Participant K)
“I also have heard that doctors … just tell me like, ‘Oh, yeah, you shouldn’t get pregnant while having diabetes.’ ‘Oh, yeah, it’s going to be a very high-risk pregnancy...’”(Participant L)
3.4. Theme 4: “Insider Knowledge”
“I wonder, if I wasn’t a nurse, would I have known to bring it [pregnancy] up that far in advance? I don’t know.”(Participant P)
“The thing I struggle with … is not everyone knows what to ask at these things [preconception visits].”(Participant N)
3.5. Theme 5: A Desire for a Different Approach to Counseling
“I think looking back I would’ve liked somebody to say something. But I also don’t think that I would’ve been receptive to it.”(Participant G)
“I think what I would have liked from that counseling would have been more of like, ‘If we work together as a medical team … this is what it looks like to have a healthy pregnancy with diabetes.’”(Participant N)
“I think that requires taking a moment and putting aside whatever preconceived notions you might have about the patient based on … age, race, what assumptions you might have of this person’s socioeconomic background.”(Participant J)
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Healy, A.M. Diabetes in Pregnancy: Preconception to Postpartum. Prim. Care Clin. Off. Pract. 2022, 49, 287–300. [Google Scholar] [CrossRef] [PubMed]
- Alexopoulos, A.-S.; Blair, R.; Peters, A.L. Management of preexisting diabetes in pregnancy: A Review. JAMA 2019, 321, 1811–1819. [Google Scholar] [CrossRef] [PubMed]
- Azeez, O. Hypertension and Diabetes in Non-Pregnant Women of Reproductive Age in the United States. Prev. Chronic Dis. 2019, 16, 190105. [Google Scholar] [CrossRef] [PubMed]
- Association, A.D. 14. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2021. Diabetes Care 2021, 44, S200–S210. [Google Scholar] [CrossRef] [PubMed]
- Simmons, D. Paradigm Shifts in the Management of Diabetes in Pregnancy: The Importance of Type 2 Diabetes and Early Hyperglycemia in Pregnancy: The 2020 Norbert Freinkel Award Lecture. Diabetes Care 2020, 44, 1075–1081. [Google Scholar] [CrossRef] [PubMed]
- Bender, W.; Durnwald, C. A Pragmatic Approach to the Treatment of Women With Type 2 Diabetes in Pregnancy. Clin. Obs. Gynecol. 2021, 64, 159–173. [Google Scholar] [CrossRef]
- Wahabi, H.A.; Alzeidan, R.A.; Bawazeer, G.A.; Alansari, L.A.; Esmaeil, S.A. Preconception care for diabetic women for improving maternal and fetal outcomes: A systematic review and meta-analysis. BMC Pregnancy Childbirth 2010, 10, 63. [Google Scholar] [CrossRef]
- Kachoria, R.; Oza-Frank, R. Receipt of preconception care among women with prepregnancy and gestational diabetes. Diabet. Med. 2014, 31, 1690–1695. [Google Scholar] [CrossRef]
- Marshall, C.; Britton, L. Delivering family planning and preconception care to women with diabetes: Implementation challenges and promising strategies. Healthcare 2019, 8, 100386. [Google Scholar] [CrossRef] [PubMed]
- Magdaleno, A.L.; Venkataraman, S.; Dion, M.; Rochon, M.; Perilli, G.; Vengrove, M.A. Preconception Counseling in Women with Diabetes by Primary Care Providers and Perceived Barriers to Initiating this Discussion. Endocr. Pract. 2020, 26, 226–234. [Google Scholar] [CrossRef] [PubMed]
- Marshall, C.J.; Huma, Z.; Deardorff, J.; Britton, L.E. Prepregnancy Counseling Among U.S. Women With Diabetes and Hypertension, 2016–2018. Am. J. Prev. Med. 2021, 61, 529–536. [Google Scholar] [CrossRef] [PubMed]
- Sofaer, S. Qualitative methods: What are they and why use them? Health Serv. Res. 1999, 34, 1101–1118. [Google Scholar] [PubMed]
- REDCap. Available online: https://www.project-redcap.org/ (accessed on 21 December 2022).
- Home | Dedoose. Available online: https://www.dedoose.com/ (accessed on 21 December 2022).
- Lincoln, Y.S.; Guba, E.G. Naturalistic Inquiry; SAGE: Thousand Oaks, CA, USA, 1985; ISBN 978-0-8039-2431-4. [Google Scholar]
- Disney, E.A.; Sanders, J.N.; Turok, D.K.; Gawron, L.M. Preconception Counseling, Contraceptive Counseling, and Long-Acting Reversible Contraception Use in Women with Type I Diabetes: A Retrospective Cohort Study. Women’s Health Rep. 2020, 1, 334–340. [Google Scholar] [CrossRef] [PubMed]
- Jazdarehee, A.; Shearer, D.; Thompson, D.; Lee, J.; Dahl, M.; Khurana, R.; Pawlowska, M. The Power of Small Conversations: Bridging the Gap Between Diabetes and Pregnancy Planning. Can. J. Diabetes 2021, 45, 714–717.e1. [Google Scholar] [CrossRef] [PubMed]
- Xu, G.; Liu, B.; Sun, Y.; Du, Y.; Snetselaar, L.G.; Hu, F.B.; Bao, W. Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: Population based study. BMJ 2018, 362, k1497. [Google Scholar] [CrossRef] [PubMed]
- Callegari, L.S.; Aiken, A.R.A.; Dehlendorf, C.; Cason, P.; Borrero, S. Addressing potential pitfalls of reproductive life planning with patient-centered counseling. Am. J. Obstet. Gynecol. 2017, 216, 129–134. [Google Scholar] [CrossRef] [PubMed]
- Callegari, L.S.; Nelson, K.M.; Arterburn, D.E.; Dehlendorf, C.; Magnusson, S.L.; Benson, S.K.; Schwarz, E.B.; Borrero, S. Development and Pilot Testing of a Patient-Centered Web-Based Reproductive Decision Support Tool for Primary Care. J. Gen. Intern. Med. 2021, 36, 2989–2999. [Google Scholar] [CrossRef] [PubMed]
Participant | Age (Years) | Race/ Ethnicity | Insurance | Education | Diabetes Type | Weeks Pregnant at Interview | Pregnancy History * | Person Pregnant with | Nature of Pregnancy |
---|---|---|---|---|---|---|---|---|---|
A | 35 | White | Private | College or more | 1 | 32 weeks | Nulliparous | Husband | [The pregnancy was] “very planned” |
B | 39 | White | Private | College or more | 1 | 9 weeks | 1 child | Husband | “…completely planned.” |
C | 40 | Latina | Private | Some college | 2 | 21 weeks | 4 children, history of miscarriage, prior abortions | Fiancé | “I took a test just randomly and it was positive … I was not ready at all.” |
D | 32 | White | Public and private | College or more | 2 | 29 weeks | Nulliparous, prior abortion | Husband | “It was something that I had decided that I definitely wanted.” |
E | 35 | Asian | Private | College or more | 2 | 9 weeks | 1 child, history of miscarriage | Husband | “We definitely discussed all the risks associated with getting pregnant at this time. And we decided that we’d give it a chance.” |
F | 33 | White and Puerto Rican | Public | College or more | Preexisting diabetes not classified as type 1 or 2 | 8 months | Nulliparous | Husband | “I tried for many years to get pregnant naturally.” |
G | 32 | White | Public and private | Some college | 2 | 13 weeks, 3 days | 1 child, history of stillbirth and fetal demise | Husband | “It wasn’t really a planned pregnancy. I had been diagnosed with diabetes type 2 for a couple of months just before this, and they were getting a hold on that, and then … I wanted to get pregnant, but I didn’t think that through.” |
H | 30 | Algerian American | Private | College or more | 1 | 8 weeks, 5 days | Nulliparous | Husband | “We were trying to get pregnant.” |
I | 35 | Asian-Indian | Private | College or more | 2 | 15 weeks | Nulliparous | Husband | “I was lucky to get pregnant in the first shot [referencing IUI].” |
J | 38 | Black | Private | College or more | 2 | 30–31 weeks | Nulliparous | Husband | “It was planned. I would say definitely planned.” |
K | 32 | Hispanic | Private | College or more | 1 | 21 weeks | Nulliparous | Husband | “It was very much planned.” |
L | 21 | White and Latina | Public | Some college | 1 | 28 weeks | Nulliparous, history of miscarriage | Boyfriend | “So, a lot of doctors have told me that there was very little, to no chance I’d get pregnant. So, I didn’t really expect it … I was shocked … I would say it was like a blessing in disguise.” |
M | 36 | Japanese American | Private | College or more | 2 | About 9 weeks | Nulliparous, history of miscarriage | Husband | “I was open to it … I think because I had the miscarriage then for this pregnancy, I was much more happy and excited when we found out we were pregnant again.” |
N | 31 | Hispanic, Asian, Black | Private | College or more | 1 | 10 weeks | Nulliparous, history of miscarriage | Husband | “I was very much intentionally trying to get pregnant again … I was excited but cautious because I had had that miscarriage.” |
O | 34 | White | Private | College or more | 1 | 20 weeks | 1 child, history of miscarriage | Husband | “We were not expecting to get pregnant as quickly … I mean, I’d say it’s planned because we really wanted a second child…” |
P | 33 | White | Private | College or more | 1 | 15 weeks | Nulliparous | Partner | “It was very much a planned one.” |
Q | 32 | White | Public and private | Some college | 1 | 26 weeks, 2 days | History of stillbirth | Husband | “We were both super happy and excited.” |
R | 38 | White and Latina | Public and private | Some college | 2 | 23 weeks | 1 child, history of miscarriage | Husband | “Because of the pandemic, we weren’t sure … I mean, it was pretty planned in a sense that we did want a second one.” |
S | 32 | White | Private | College or more | 1 | 14 weeks | Nulliparous, history of miscarriage | Husband | “We were definitely actively trying.” |
T | 37 | Mexican, Italian, Native American | Public | Some college | 2 | 15 weeks | Nulliparous, prior abortion | Boyfriend | “It was a planned, I guess a planned surprise.” |
U | 35 | Native American | Public | Some college | 2 | 15 weeks | 2 children, history of miscarriage | Husband | “It was [planned], but it was still kind of a surprise just because I wasn’t actually trying yet.” |
V | 32 | White and Asian | Private | College or more | 1 | About 8 weeks | Nulliparous | Husband | “I wasn’t expecting it to just happen right away … I was very open, very excited with two positive tests.” |
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Marshall, C.J.; Parham, L.; Hubbard, E.; Irani, R.A. Experiences of Preconception Counseling among Pregnant Women with Preexisting Diabetes: Opportunities to Improve Patient-Centered Care. Int. J. Environ. Res. Public Health 2023, 20, 2908. https://doi.org/10.3390/ijerph20042908
Marshall CJ, Parham L, Hubbard E, Irani RA. Experiences of Preconception Counseling among Pregnant Women with Preexisting Diabetes: Opportunities to Improve Patient-Centered Care. International Journal of Environmental Research and Public Health. 2023; 20(4):2908. https://doi.org/10.3390/ijerph20042908
Chicago/Turabian StyleMarshall, Cassondra J., Lindsay Parham, Erin Hubbard, and Roxanna A. Irani. 2023. "Experiences of Preconception Counseling among Pregnant Women with Preexisting Diabetes: Opportunities to Improve Patient-Centered Care" International Journal of Environmental Research and Public Health 20, no. 4: 2908. https://doi.org/10.3390/ijerph20042908
APA StyleMarshall, C. J., Parham, L., Hubbard, E., & Irani, R. A. (2023). Experiences of Preconception Counseling among Pregnant Women with Preexisting Diabetes: Opportunities to Improve Patient-Centered Care. International Journal of Environmental Research and Public Health, 20(4), 2908. https://doi.org/10.3390/ijerph20042908