title: Diabetes and pregnancy. Factors associated with seeking pre-conception care.
abstract: OBJECTIVE
  To define sociodemographic characteristics, medical factors, knowledge, attitudes, and health-related behaviors that distinguish women with established diabetes who seek pre-conception care from those who seek care only after conception.
  
  
  METHODS
  A multicenter, case-control study of women with established diabetes making their first pre-conception visit (n = 57) or first prenatal visit without having received pre-conception care (n = 97).
  
  
  RESULTS
  Pre-conception subjects were significantly more likely to be married (93 vs. 51%), living with their partners (93 vs. 60%), and employed (78 vs. 41%); to have higher levels of education (73% beyond high school vs. 41%) and income (86% > $20,000 vs. 60%); and to have insulin-dependent diabetes mellitus (IDDM) (93 vs. 81%). Pre-conception subjects with IDDM were more likely to have discussed pre-conception care with their health care providers (98 vs. 51%) and to have been encouraged to get it (77 vs. 43%). In the prenatal group, only 24% of pregnancies were planned. Pre-conception patients were more knowledgeable about diabetes, perceived greater benefits of pre-conception care, and received more instrumental support.
  
  
  CONCLUSIONS
  Only about one-third of women with established diabetes receive pre-conception care. Interventions must address prevention of unintended pregnancy. Providers must regard every visit with a diabetic woman as a pre-conception visit. Contraception must be explicitly discussed, and pregnancies should be planned. In counseling, the benefits of pre-conception care should be stressed and the support of families and friends should be elicited.
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor 48109-2029, USA.
authors.forename: N K
authors.initials: NK
authors.lastname: Janz
authors.forename: W H
authors.initials: WH
authors.lastname: Herman
authors.forename: M P
authors.initials: MP
authors.lastname: Becker
authors.forename: D
authors.initials: D
authors.lastname: Charron-Prochownik
authors.forename: V L
authors.initials: VL
authors.lastname: Shayna
authors.forename: T G
authors.initials: TG
authors.lastname: Lesnick
authors.forename: S J
authors.initials: SJ
authors.lastname: Jacober
authors.forename: J D
authors.initials: JD
authors.lastname: Fachnie
authors.forename: D F
authors.initials: DF
authors.lastname: Kruger
authors.forename: J A
authors.initials: JA
authors.lastname: Sanfield
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003710:Demography; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology; D004493:Education; D004651:Employment; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007182:Income; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000523:psychology*; D011295:Prenatal Care; D012944:Social Support; D012959:Socioeconomic Factors