Youth With Type 2 Diabetes Have Low Rates of Contraception and Preconception Counseling Documentation Compared With Adults With Diabetes

INTRODUCTION: To explore the frequency of preconception and contraceptive counseling and LARC use in type I diabetic women. METHODS: This retrospective cohort study identified women (16-49 years-old) with an ICD-9/ICD-10 code for type I diabetes and documented A1C level in a tertiary referral center between 1/1/2010-10/30/2017. We abstracted preconception or contraceptive counseling and LARC documentation within 1 year pre- and post-highest A1C. We identified provider type: primary care (PCP), endocrinology, obstetrics/gynecology (OB/GYN), and maternal fetal medicine (MFM). We defined advanced disease by micro- or macro-vascular complications or disease >20 years. Multivariable logistic regression related disease severity and provider type to counseling and LARC documentation when controlling for age and race. RESULTS: We included 541 women. Median age was 30.7 (range 17-49), A1C was 9.1% (5%-20%), and median 4 visits (range 1-38) during the two-year span. Only 5% received preconception counseling, 25% received contraceptive counseling, and 13% used LARC. MFMs most frequently documented preconception counseling (16%, P=0.01), while OB/GYNs most frequently documented contraceptive counseling (73%, P<0.01). LARC documentation was higher in MFM (26%) and OB/GYN (27%) visits compared to endocrinology (10%) and PCP (11%) visits (all P<0.01). Advanced disease resulted in less preconception counseling (3%, P=0.05), yet similar contraceptive counseling frequency and LARC use compared to non-advanced disease. Contraceptive counseling was highly associated with LARC use (aOR 9.87, 95% CI 5.09-19.12). CONCLUSION: Reproductive age type I diabetic women have high healthcare utilization, yet documentation of preconception and contraceptive counseling is sparse. Educating non-OB/GYN providers could avoid missed opportunities to improve pregnancy planning and outcomes.

Introduction To provide quality family planning services and reduce racial and socioeconomic disparities in unintended pregnancy and pregnancy outcomes, primary care clinicians should routinely assess women's reproductive health needs and provide patient-centered contraceptive and preconception counseling. One Key Question® asks women if they would like to become pregnant in the next year and prompts clinicians to provide counseling appropriate to each patient. We conducted a pilot study to assess if implementing One Key Question® in the Electronic Medical Record (EMR) of an urban community health center, coupled with brief clinician training, would increase rates of contraceptive and preconception counseling. Methods We incorporated One Key Question® into a new EMR form and provided a brief training to primary care clinicians on reproductive life plan assessment, preconception counseling, and contraception. We surveyed women patients, ages 18-49, after their visit and compared pre- vsersus post-intervention rates of patient-reported contraceptive and preconception counseling. Results After One Key Question® was introduced in the clinic EMR and clinicians underwent brief training on its use, patients reported significantly higher rates of their clinician counseling them about contraception (52% vs. 76%, p = 0.040) and recommending a long-acting reversible contraceptive (LARC) method (10% vs. 32%, p = 0.035). There were no significant changes in preconception counseling. Discussion After EMR integration of One Key Question® coupled with brief clinician training, rates of contraceptive counseling and LARC recommendations increased in this community health center pilot study. Future research should compare One Key Question® to standard care in a prospective randomized trial.

Contraception and preconception counseling in women with autoimmune disease.

Contraceptive use and counseling in patients with systemic lupus erythematosus

Numerous studies indicate that non-White individuals and/or those who are of low socioeconomic status (SES) are preferentially prescribed long-acting reversible contraception more frequently than their white counterparts. This cohort is also more likely to have medical and obstetric complications that put them at high risk for adverse pregnancy outcomes due to the systematic racism within the medical system and its interaction with underlying conditions. Medical complications themselves may be a risk factor for contraceptive coercion. We looked to evaluate if contraceptive use and patient perception of contraceptive counseling is impacted by obstetric risk factors for adverse pregnancy outcomes, and if this varies by SES or race/ethnicity. This is a retrospective analysis of the National Survey of Family Growth (NSFG) 2017-2019 cohort. Participants were grouped into categories of either high or low risk for adverse birth outcomes. The primary outcome was contraceptive choice. Bivariate comparison was performed using complex survey weighting. Secondary outcomes included participant ratings of provider counseling and respect. Multivariable regression was performed for use of long-acting reversible contraceptives, accounting for demographic variables that were significantly different between groups. A total of 1655 participants met inclusion criteria for this analysis. Of these participants, 310 were at risk for adverse pregnancy outcomes as defined by study criteria. Participants at risk for adverse pregnancy outcomes were more likely to receive public assistance, have fewer years of formal education, and were less likely to report having "good" or "excellent health". There were no differences in the types of contraceptives used in the last 12 months between those at high risk for adverse pregnancy outcomes and those with low risk. Between groups, there were no differences of participant ratings of provider counseling and respect. Participants in the NSFG reported no differences in contraceptive methods when comparing those at high risk for adverse pregnancy outcomes as compared to those with low risk.

BackgroundPregnancy in patients with systemic autoimmune diseases (SADs) are known to be at high risk for the occurrence of adverse pregnancy outcomes. Pre-conception counselling and risk stratification performed in a...

BackgroundTo maximise the potential for reducing the risk of adverse pregnancy outcomes, preconception counselling (PCC) is used to inform couples contemplating pregnancy about general and personal risk factors. Many initiatives have been developed to provide PCC, but none offers it routinely in a presumed low-risk population.The objective of the study was to investigate the extent to which women contemplating pregnancy can be reached when a PCC programme is routinely offered by general practitioners (GPs).Methods30 GPs actively offered PCC to all women aged 18 to 40 over a three-year period. GPs reviewed lists of these women and excluded women with adverse social circumstances. The remaining women received an invitation for PCC. They were requested to indicate whether they were interested in PCC, and if so, when they were contemplating pregnancy. Those both interested and contemplating pregnancy within one year were invited for PCC. All pregnancies occurring within one year of an invitation were monitored. Response rates and percentages of pregnancies preceded by an invitation or actual attendance to PCC were calculated.ResultsOverall, 72–75% of the interested responders, who returned the risk-assessment questionnaire (80%), actually attended PCC. However, the GPs excluded a large number of women. In 2002 27% of all pregnancies occurred in the group of women who had been interested and had indicated that they hoped to get pregnant within one year. Another 33% of the pregnancies occurred in the group of women who had been excluded, 13% in the group who had not responded, and 14% in the group who had not been interested.ConclusionA quarter of the women who became pregnant in the year after the invitation were reached in time. In order to increase this number, methods should be developed to decrease the exclusion of women by the GPs and to increase women's response.

BackgroundThe Endocrine Society recommends preconception counseling be provided to all women with DM who are considering pregnancy; the ADA recommends counseling women of childbearing age with DM on the importance of tight pregnancy glycemic control and appropriate use of contraception at pubertal onset. However, only 25% of women receive contraception and preconception counseling (PCC). As most studies are retrospective chart reviews, what is cited may not reflect the PCC offered.MethodsPhysicians and advanced care providers (n=97) at one institution were surveyed on their behaviors in offering and documenting PCC provided to women with T1DM and T2DM.Women with T1DM and T2DM (n=15) receiving care at the same institution were contacted after a recent endocrine visit and surveyed on the PCC they received. A retrospective chart review examined how the women's perception of the PCC provided correlated with documentation.Additionally, similar surveys were distributed to women aged 18 to 50 via diabetes groups on a social media platform (n=202).ResultsOverall, 37% of providers reported offering PCC < 5% of the time; PCPs and pediatric endocrinologists were least likely to offer PCC (p<0.01 between all groups). The majority of OBGYNs and endocrinologists shared PCC up to 25% of the time (p >0.05).Providers were most likely to educate on or prescribe contraception. Half said they document counseling >75% of the time.Of all the women surveyed (n=217), 89% had T1DM, 91% were White and the average HbA1c was in the 6.6%-6.9% range. 59% of women reported previous pregnancies and 6.9% were pregnant. There was no difference in HbA1cs for those planning or considering pregnancy and those who were not (HbA1c 7% v 6.7%, p >0.05 in chart review survey; HbA1c 6.6-6.9% in both groups in social media survey, p >0.05).55% reported receiving PCC in the past, most likely from their endocrinologist or OBGYN.The most frequently reported forms of contraception were OCPs (22%) followed by barrier contraception (18%)–generally with other methods—followed by no form of contraception (15%).In the chart review survey (n=15), none were currently pregnant but 13% were planning pregnancy in the next year and 47% were unsure of their plans. Two reported PCC was discussed at their most recent visit; one reported receiving PCC at the penultimate visit. Of these three visits, PCC was documented twice. Topics commonly discussed were glycemic targets, preconception planning, and contraception.ConclusionThis study suggests the rates of lifetime PCC are higher than described and lower reported rates may be related to deficiencies in documentation. However, the small size of the chart review survey limits the ability to draw definitive conclusions. This study may also be limited by self-selection bias and over-representation of White patients among survey respondents.Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Sunday, June 12, 2022 12:48 p.m. - 12:53 p.m.

60 - Randomized Phase 2 Study of Guadecitabine in Patients with HMA-Naive Higher Risk Myelodysplastic Syndromes (MDS) or Chronic Myelomonocytic Leukemia (CMML)

Background: This 2016 study aimed to investigate the training in contraception and preconception counseling received by cardiovascular science fellows. Method: The authors surveyed current adult and pediatric cardiology fellows in the United States. Questions assessed the availability of family planning counseling training within their training program, current practices of contraception and preconception counseling, and use of available tools for risk stratification of patients. Bivariate logistic regressions were utilized to predict demographic variables associated with survey responses, and associations between hours of training or perceived preparedness and clinical use of training. Results: There were 101 survey responses. Most participating fellows disagreed that their fellowship training had prepared them to counsel patients on contraception (69%) and preconception planning (62%). Sixty-one percent of participants do not routinely discuss contraception options and 55% do not routinely discuss preconception counseling with reproductive-age female patients at routine visits. Having more than 1 hour of training was predictive of more consistent counseling for both contraception and preconception counseling. Approximately 40% of participants routinely refer patients to an OB/Gyn for contraception or preconception counseling. Conclusion: This study highlights the need for increased training in contraceptive and preconception counseling within adult and pediatric cardiology fellowship programs.

To investigate the association between metabolic dysfunction-associated steatotic liver disease (MASLD) and the risk of adverse pregnancy outcomes, and to analyze the impact of the type and severity of cardiometabolic risk factor (CMRF) abnormalities on this association. A retrospective cohort study was conducted among primiparous women with singleton pregnancies who had registered at Beijing Friendship Hospital from March 10, 2020, to December 31, 2022. A total of 2 623 women were included. Basic characteristics and delivery outcomes were documented, liver ultrasound and relevant prenatal examinations were performed, and adverse pregnancy outcomes were diagnosed. Modified Poisson regression models were used to analyze the association between MASLD and adverse pregnancy outcomes. The relationship between the type or severity of CMRF abnormalities in MASLD and the risk of adverse pregnancy outcomes was also explored. After adjusting for confounding factors including age, gestational weight gain, and education level, MASLD was associated with an increased risk of cesarean section (RR=1.531, 95%CI: 1.304-1.799, P < 0.001), gestational diabetes mellitus (GDM; RR=2.409, 95%CI: 1.948-2.979, P < 0.001), pregnancy-associated hypertension (PAH; RR=3.062, 95%CI: 2.069-4.533, P < 0.001), preterm birth (RR=2.145, 95%CI: 1.342-3.429, P=0.001), and large for gestational age (LGA; 2.224, 95%CI: 1.599-3.095, P < 0.001). However, no significant associations were found for small for gestational age or postpartum hemorrhage. After adjusting for other CMRF abnormalities, the risk of adverse pregnancy outcomes varied among MASLD pregnant women with different CMRF abnormalities: the body mass index abnormal group had higher risks of cesarean section, GDM, PAH, preterm birth, and LGA; the glucose abnormal group had an increased risk of GDM; the blood pressure abnormal group had a higher risk of PAH; the high density lipoprotein cholesterol abnormal group had higher risks of cesarean section, GDM, and PAH; and the triglyceride abnormal group was associated with higher risks of GDM and preterm birth. Additional, as the severity of CMRF abnormalities increased, the risks of cesarean section (RR=1.199, 95%CI: 1.112-1.292, P < 0.001), GDM (RR=1.478, 95%CI: 1.345-1.624, P < 0.001), PAH (RR=1.626, 95%CI: 1.367-1.934, P < 0.001), preterm birth (RR=1.384, 95%CI: 1.120-1.710, P=0.003), and LGA (RR=1.422, 95%CI: 1.224-1.650, P < 0.001) continued to rise. MASLD during pregnancy is associated with an increased risk of multiple adverse pregnancy outcomes, and the type and severity of CMRF abnormalities significantly influence this association. These results suggest that attention should be paid to the specific CMRF abnormalities when diagnosed MASLD, as this may help to facilitate targeted interventions and reduce the risk of adverse pregnancy outcomes.

Preconception counseling for reproductive-age women with type 1 and type 2 DM improves maternal-fetal outcomes. Endocrinologists are in a unique position to provide such important counseling and contraception or applicable referrals. In response to an increasing number of women referred to our prenatal clinic with poor glycemic control and unplanned pregnancies, we instituted a quality improvement initiative to improve preconception care at our academic center. We conducted a chart review of 96 women of reproductive age with at least one in-person visit for DM from July 2020-Oct 2021. Patients who were pregnant or had undergone sterilization were excluded. Fifty patients (mean age 34.5+/-6.7 yrs) met inclusion criteria. Of these, 66% had T1DM, 32% had T2DM and 26% had a HgbA1c ≤6.5%, recommended for pregnancy. Each woman had a mean of 2.1+/-1.2 visits with an endocrinology provider during these 15 mos. Only 4% had contraception specifically documented during a visit, although medical staff or other providers had documented contraception use in 56% of cases. No women received a contraception prescription. Endocrinologists did not document provision of preconception counseling to any of these women, although 14% had previously undergone counseling with a maternal fetal medicine provider. No women were referred to an OB-Gyn provider. Our data suggest that endocrinology providers infrequently provide preconception or contraception counseling or referrals for women with diabetes and underscores the striking need for a QI initiative. To this end, we are implementing a multifaceted intervention to educate providers on key aspects of preconception counseling and contraception provision, facilitate specialist referrals, simplify documentation, and provide patient education materials. We will assess the efficacy of our intervention with the ultimate goal of improving outcomes for this rapidly growing population of women with diabetes and their offspring. Disclosure R.Jeffers: None. L.Sayres: None. L.Abushamat: None. C.Nielsen: None. A.Zaman: None. L.A.Barbour: None.

The Power of Small Conversations: Bridging the Gap Between Diabetes and Pregnancy Planning

Counselling and pregnancy outcomes in women with congenital heart disease- current status and gap analysis from Madras Medical College Pregnancy And Cardiac disease (M-PAC) registry

The outcome of pregnancy can be influenced by several risk factors. Women who are informed about these risks during pre-conception counselling (PCC) have an opportunity to take preventive measures in time. Several studies have shown that high-risk populations have a high prevalence of such risk factors. However, prevalence in the general population, which is assumed to be low risk, is largely unknown. We therefore provided a systematic programme of PCC for the general population and studied the prevalence of risk factors using the risk-assessment questionnaire which was part of the PCC. None of the couples reported no risk factors at all and only 2% of the couples reported risk factors for which written information was considered to be sufficient. Therefore, 98% of all couples reported one or more risk factors for which at least personal counselling by a general practitioner (GP) was indicated. Many of these factors were related to an unhealthy lifestyle. Women with a low level of education reported more risk factors than women with a high level of education. There is a great need for PCC as shown by the fact that almost all couples reported risk factors for which personal counselling was indicated. Pre-conception counselling may reduce the risk of adverse pregnancy outcome by enabling couples to avoid these risks. PCC can be provided by GPs, who have the necessary medical knowledge and background information to counsel couples who wish to have a baby.