title: Use of a modified reproductive life plan to improve awareness of preconception health in women with chronic disease.
abstract: OBJECTIVE
  Chronic diseases such as hypertension, diabetes, and obesity pose unique reproductive challenges for women. Preconception health results in improved reproductive outcomes. We designed an interventional study testing the use of a reproductive life plan to improve knowledge of preconception and contraception health in women with chronic diseases.
  
  
  METHODS
  Primarily underserved, English-and Spanish-speaking women aged 18 to 40 years with active diabetes, hypertension, or obesity were recruited. We developed a revised reproductive life plan specific to these diseases. Two resident physicians performed reproductive plan counseling. Pre- and postcounseling surveys were administered to evaluate knowledge and attitudes about chronic disease and the effects on a potential pregnancy.
  
  
  RESULTS
  Twenty-seven women (average age = 31 years) were surveyed. Of the subjects, 85.2% were obese, 29.6% had hypertension, and 7.4% had diabetes. Significant increases were reported in understanding risks of pregnancy associated with diabetes (p < 0.001), hypertension (p < 0.001), and obesity (p < 0.01). After counseling, women increased their knowledge about a reproductive plan (p < 0.001) and increased support and information to make reproductive health choices (p = 0.001 and p < 0.01, respectively). The largest improvements in postcounseling variables occurred in women with the lowest precounseling test scores and in women without children.
  
  
  CONCLUSIONS
  A reproductive life plan is a brief, cost-effective preconception and contraception counseling tool in the primary care setting for women with chronic diseases. This tool increases knowledge about reproductive health and enables women with chronic diseases to make informed decisions about their reproductive future.
authors.affiliation: Assistant Clinical Professor in the Department of Family and Community Medicine at the University of California, San Francisco. mittalp@fcm.ucsf.edu.
authors.forename: Pooja
authors.initials: P
authors.lastname: Mittal
authors.affiliation: Associate Physician in Family Medicine at La Clinica De La Raza in Oakland, CA. apaws1@gmail.com.
authors.forename: Aparna
authors.initials: A
authors.lastname: Dandekar
authors.affiliation: Assistant Professor in the Department of Family and Community Medicine at the University of California, San Francisco. hesslerd@fcm.ucsf.edu.
authors.forename: Danielle
authors.initials: D
authors.lastname: Hessler
mesh_terms: D000328:Adult; D001364:Awareness; D002140:California / Q000453:epidemiology; D002908:Chronic Disease; D032882:Comprehension; D003267:Contraception; D003625:Data Collection; D003920:Diabetes Mellitus / Q000453:epidemiology; D037001:Directive Counseling / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology; D010353:Patient Education as Topic; D016742:Preconception Care; D011247:Pregnancy; D011248:Pregnancy Complications; D015995:Prevalence; D012306:Risk; D014930:Women; D055815:Young Adult