Pregnancy planning in women with pregestational diabetes.
OBJECTIVE
Women with pregestational diabetes are advised to plan their pregnancies to optimize glycemia and reduce fetal complications. We evaluated the adequacy of pregnancy planning effort and medical planning in pregnant women with type 1 and type 2 diabetes.


METHODS
This retrospective cohort study surveyed pregnant women with pregestational diabetes mellitus between 2006 and 2008 in Ontario, Canada. We evaluated three measures of pregnancy planning: pregnancy planning effort, medical planning based on prepregnancy glycemic control, and folic acid use. We compared women with type 1 and type 2 diabetes and explored predictors of pregnancy planning.


RESULTS
Of the 163 women studied (89 type 1, 74 type 2 diabetes), 47% reported high pregnancy planning effort, 58% reported attempts to optimize glycemic control, and 56% took folic acid before pregnancy. Of those who reported high pregnancy planning, 20% did not medically plan their pregnancies. Rates were similar between women with type 1 and type 2 diabetes. The most important predictor of pregnancy planning was having discussed plans with their physician.


CONCLUSIONS
Our findings suggest that pregnancy planning is suboptimal in women with both type 1 and type 2 diabetes, highlighting a need to improve preconception counseling for all women with pregestational diabetes.
Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada. lorraine.lipscombe@wchospital.ca
Lorraine L
LL
Lipscombe
Heather M
HM
McLaughlin
Wei
W
Wu
Denice S
DS
Feig
D000328:Adult; D001294:Attitude to Health; D015331:Cohort Studies; D003376:Counseling; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D005193:Family Planning Services / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D033182:Intention; D010934:Planning Techniques; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D055815:Young Adult