1149 Association between preconception counseling and glucose control at conception in patients with pre-existing diabetes mellitus

Abstract

To determine if preconception counseling for patients with pre-existing diabetes mellitus (DM) differs between obstetricians and other providers with regard to frequency, content, or association with early pregnancy glycemic control. All patients with pre-existing DM in our Diabetes in Pregnancy clinic, which cares for more than 50% of the state’s pregnant patients with DM, were screened for enrollment. To be included, participants had to able to read English, have pre-existing diabetes, have seen a provider within the previous year, and be less than 28 weeks gestation. Demographics and medical history were collected from the questionnaires and medical charts. The study was powered to detect a 1% difference in early pregnancy hemoglobin A1c between patients who saw an obstetrician compared to another type of provider. From May 2015 to Dec. 2019, 195 eligible patients were approached and 161 patients completed the questionnaire; 45% were seen by an obstetrician and 55% by another provider. Patients seen by an obstetrician were more educated, more likely to be partnered, and report a shorter inter-pregnancy interval. In total, only 46% of pregnancies were planned; 42% of patients reported any preconception counseling; 48% were informed of the importance of preconception HgbA1c; and 57% were advised how diabetes may impact their pregnancy. Although obstetricians were more likely to review some critical elements of preconception counseling, there was no difference in total amount of preconception counseling between provider types once maternal characteristics were adjusted for. Early HgbA1c was lower among patients who saw an obstetrician compared to other provider (7.6% vs 8.3%, p=0.045), but when maternal characteristics were adjusted for, there was no association between HgbA1c and provider type. Given the low rate of preconception counseling among obstetricians and other providers, education is needed advocating that all reproductive aged patients with pre-existing DM receive information on the importance of optimizing glucose control for improved pregnancy outcomes.