‘Women with Diabetes: Things you need to know (but maybe don’t!)’: A pre-conception counselling resource to raise awareness of the importance of pre-pregnancy care among women with diabetes

Summary

Funded by Diabetes UK the aim of the “Women with Diabetes” resource is to increase women’s awareness about the importance of planning for pregnancy and to positively influence attitudes, self-efficacy and intentions towards seeking pre-pregnancy care and preventing unplanned pregnancies. Originally produced as a DVD and later converted to a website, the resource was designed and developed in collaboration with women with diabetes under the direction of healthcare professionals in accordance with NICE pre-pregnancy care guidance. This resource has been embedded in routine care in Northern Ireland since 2010.  An evaluation of the DVD among 97 women with diabetes demonstrated that it was effective in increasing knowledge and enhancing attitudes of women with diabetes to pre-pregnancy care.

Challenge

Rates of stillbirth, perinatal mortality and congenital anomaly are higher in women with diabetes compared with the general maternity population. Pre-pregnancy care is cost-effective and reduces adverse outcomes, yet not all women with diabetes are informed about the need or rationale for pre-pregnancy care, ultimately leading to poor uptake.

Although there is an increasing realisation that pre-pregnancy care is advantageous, most women only seek medical advice once they are pregnant. The National Institute for Health and Clinical Excellence (NICE) stressed the importance of effective pre-conception counselling and recommends that: ‘Women of childbearing age with diabetes are regularly informed of the benefits of pre-conception glycaemic control and of any risks, including medication that may harm an unborn child. Women with diabetes planning a pregnancy are offered pre-conception care and those not planning a pregnancy are offered advice on contraception.’

Despite these guidelines, rates of pre-conception counselling remain low and innovative strategies are urgently needed to increase the proportion of women seeking it.

Objectives

The aim of this initiative was to design, develop, pilot and evaluate an interactive DVD as an effective educational tool emphasising the importance of planning for pregnancy and to prevent unplanned pregnancies. The long term goal of the DVD, recently converted for website delivery, is to improve pregnancy management and outcome by increasing the proportion of women who plan their pregnancies and seek pre-pregnancy care. The ambition was to produce an effective tool which can be used by healthcare professionals to counsel women in what can be a very sensitive area.

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