title: Personal experiences of women with diabetes who do not attend pre-pregnancy care.
abstract: OBJECTIVE
  To explore the views of women who did not attend pre-pregnancy care (PPC), in particular their accounts of contraception, previous pregnancies and the influence of healthcare advice.
  
  
  METHODS
  We conducted semi-structured interviews with 29 pregnant women (21 with Type 1 diabetes, eight with Type 2 diabetes) at three UK specialist diabetes antenatal clinics. Interviews explored women's journeys to becoming pregnant, including use of contraception, their views regarding diabetes and pregnancy and the factors which encouraged and discouraged them from attending PPC.
  
  
  RESULTS
  All women had some understanding of the issues concerning diabetes during pregnancy, predominantly regarding the benefits of PPC (90%) and optimal glycaemic control (80%) and risks of malformation (48%) and macrosomia (35%). Most were not regularly using contraception (70%), having stopped deliberately (45%), become unintentionally less rigorous (28%) or experienced side effects/contraindications (14%). Knowledge concerning the risks of pregnancy (90%) and past pre-conception counselling (38%) did not encourage women to attend PPC, and neither did personal experience of miscarriage, malformation or stillbirth in women with previous poor pregnancy outcome (41%). Barriers included conceiving faster than anticipated (45%), fertility concerns (31%), negative experiences with health professionals (21%), desire for a 'normal' pregnancy (17%) and the logistics of attending (10%).
  
  
  CONCLUSIONS
  More integrated diabetes and reproductive health/contraceptive advice, increased awareness of the potentially short time between stopping contraception and conception and more intensive support between pregnancies are required, particularly for women with previously poor outcomes. Research is also needed into how communication between health professionals and women with diabetes can be improved.
authors.affiliation: University of Cambridge, Metabolic Research Laboratories, Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, UK. hm386@medschl.cam.ac.uk
authors.forename: H R
authors.initials: HR
authors.lastname: Murphy
authors.forename: R C
authors.initials: RC
authors.lastname: Temple
authors.forename: V E
authors.initials: VE
authors.lastname: Ball
authors.forename: J M
authors.initials: JM
authors.lastname: Roland
authors.forename: S
authors.initials: S
authors.lastname: Steel
authors.forename: R
authors.initials: R
authors.lastname: Zill-E-Huma
authors.forename: D
authors.initials: D
authors.lastname: Simmons
authors.forename: L R
authors.initials: LR
authors.lastname: Royce
authors.forename: T C
authors.initials: TC
authors.lastname: Skinner
mesh_terms: D000328:Adult; D001294:Attitude to Health; D003270:Contraceptive Agents; D003376:Counseling; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016742:Preconception Care / Q000379:methods*; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000453:epidemiology / Q000523:psychology*; D018566:Pregnancy, High-Risk / Q000523:psychology*; D011295:Prenatal Care / Q000379:methods*; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D003270:Contraceptive Agents