Preconception Counselling Resource Improves Pregnancy Care in Women With Diabetes Interview with:

Dr Valerie Holmes Senior Lecturer Centre for Public Health School of Medicine, Dentistry and Biomedical Science Queen's University Belfast Belfast

Dr. Valerie Holmes

Dr Valerie Holmes
Senior Lecturer
Centre for Public Health
School of Medicine, Dentistry and Biomedical Science
Queen’s University Belfast
Belfast What is the background for this study?

Response: Women with diabetes, type 1 diabetes and type 2 diabetes, are advised to plan for pregnancy as there are higher risks of complications for both the mother and baby when compared to the general maternity population. Careful planning in partnership with diabetes care teams, especially in relation to achieving optimum blood glucose control and taking folic acid can significantly reduce the risks. However, while most women know that they should plan for pregnancy, they are unaware as to why this is important or how to engage with the process, and thus the majority of women (up to two thirds of women) enter pregnancy unprepared. This study describes the implementation of a regional preconception counsellng resource, in the format of a DVD, into routine care in Northern Ireland to raise awareness of pregnancy planning. The authors assessed if the introduction of this resource improved pregnancy planning among women with diabetes in the region. What are the main findings?

Response: Following an intensive distribution campaign, 62% of women who attended clinic for antenatal care reported receiving the DVD, and 42% of women reported viewing the DVD. Fewer women with type 2 diabetes received the DVD when compared to women with type 1 diabetes (30% vs 70%). Overall women who attended clinic for antenatal care were better prepared for pregnancy after the DVD distribution campaign when compared to women in the period before availability of the DVD, although changes in these pregnancy planning indicators did not reach statistical significance. When the authors compared those women who viewed the DVD to women in the period before the DVD there was evidence of improved pregnancy planning in the viewed DVD group. Women who viewed the DVD had significantly lower HbA1C at their first antenatal visit (an indicator of better blood glucose control) and were more likely to have taken folic acid (81% vs 43). In addition, only 9% of women who watched the DVD reported taking no action in relation to pregnancy planning. What should readers take away from your report?

Response: This preconception counsellng resource was effective in improving pregnancy planning indicators in women who viewed the resource. Women with type 2 diabetes, who are typically looked after in primary care were more difficult to reach. All healthcare professionals looking after women with diabetes, especially those in primary care, should be aware of the importance of preconception counseling, and use each contact as an opportunity to highlight its importance. What recommendations do you have for future research as a result of this study?

Response: Further research is required to establish how best to ensure that we reach all women with diabetes in relation to preconception counseling. In particular, research is needed to establish how we can better engage primary care providers in the provision of preconception counseling. Is there anything else you would like to add?

Response: The DVD used in this study has been converted to a mobile friendly website: This website has an interface designed specifically for women with diabetes to raise awareness of pregnancy planning, contraception and the diabetes and pregnancy journey. In addition, there is also has an e-learning continuing professional development interface for healthcare professionals to provide them with evidence based information and thus empower them to have that all important preconception counseling conversation with women at each contact. Thank you for your contribution to the community.


Prim Care Diabetes. 2016 Jul 27. pii: S1751-9918(16)30057-2. doi: 10.1016/j.pcd.2016.07.005. [Epub ahead of print]
Effect of implementation of a preconception counselling resource for women with diabetes: A population based study.
Holmes VA1, Hamill LL2, Alderdice FA3, Spence M4, Harper R5, Patterson CC2, Loughridge S6, McKenna S6, Gough A2, McCance DR6; Women with Diabetes Project Team.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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