NDSS Diabetes in Pregnancy National Development Program

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1 NDSS Diabetes in Pregnancy Natinal Develpment Prgram Cntraceptin, Pregnancy & Wmen s Health Survey Summary reprt August 15 The Diabetes in Pregnancy Natinal Develpment Prgram is funded as part f the Natinal Diabetes Services Scheme which is an initiative f the Australian Gvernment administered by Diabetes Australia. Leadership fr the Diabetes in Pregnancy Natinal Develpment Prgram is prvided by Diabetes NSW.

2 Acknwledgments The NDSS Cntraceptin, Pregnancy & Wmen s Health Survey was undertaken by the NDSS Diabetes in Pregnancy Prject team in cnjunctin NDSS Diabetes in Pregnancy Expert Reference Grup. Assistance was kindly prvided by the Type 1 Diabetes Netwrk, NDSS agents frm acrss Australia, Diabetes Victria, Australian Centre fr Behaviural Research in Diabetes, Diabetes Cunselling Online, Diabetgenic nline blg, Australian Diabetes Educatrs Assciatin and health prfessinals wrking with wmen with diabetes. The NDSS Diabetes in Pregnancy NDP team wuld like t sincerely thank the wmen with diabetes wh participated in this survey.

3 Cntents NDSS Diabetes in Pregnancy Natinal Develpment Prgram... 2 The Cntraceptin, Pregnancy & Wmen s Health Survey... 2 Abut the survey... 3 Abut the results Diabetes management and health care Pregnancy and cntraceptin infrmatin Pregnancy and diabetes Beliefs abut pregnancy and cntraceptin Pregnancy and diabetes infrmatin A summary f the results... Next steps References

4 NDSS Diabetes in Pregnancy Natinal Develpment Prgram The NDSS Diabetes in Pregnancy Natinal Develpment Prgram (NDP) aims t address the need fr pre-pregnancy planning and care in wmen with diabetes and prmte ptimal diabetes management during pregnancy. T identify strategies fr the NDSS Diabetes in Pregnancy NDP and guide the develpment f prject activities, a needs assessment was undertaken with wmen with type 1 and type 2 diabetes The Cntraceptin, Pregnancy & Wmen s Health Survey The NDSS Cntraceptin, Pregnancy & Wmen s Health Survey was a natinal survey f wmen with type 1 r type 2 diabetes undertaken t better understand awareness, knwledge and beliefs regarding pregnancy as well as the infrmatin and supprt needs f wmen. This reprt summarises sme f the key findings f this survey and makes recmmendatins fr strategies t address the infrmatin and supprt needs f Australian wmen with diabetes in relatin t precnceptin cunselling and pre-pregnancy care. The aims f this survey were t: 1. Determine recall f precnceptin cunselling amng Australian wmen with diabetes; 2. Describe wmen s experiences with precnceptin cunselling and identify factrs assciated with prvisin f precnceptin cunselling; 3. Determine the current level f knwledge abut cntraceptin, pregnancy and diabetes amng wmen with diabetes; 4. Describe attitudes and beliefs f wmen with diabetes in relatin t pregnancy, cntraceptin and family planning; 5. Determine awareness f the need fr pre-pregnancy care and intentin t seek prepregnancy care amng wmen with diabetes; 6. Describe wmen s experiences with pre-pregnancy care and factrs assciated with the uptake f pre-pregnancy care amng wmen with prir pregnancies; 7. Identify the infrmatin needs f wmen in relatin t pregnancy and diabetes and preferred frmat fr receiving infrmatin; and 8. Identify apprpriate strategies fr reminding wmen f the need t plan and prepare fr pregnancy and determine perceptins f an NDSS delivered pregnancy reminder system. 2

5 Abut the survey The self-administered survey was available available nline r as a written pstal survey. The prject was apprved by Deakin University Human Research Ethics Cmmittee. The survey questins The survey questins were based n diabetes and pregnancy guidelines, 1,2,3 the findings frm a prject literature review and cnsultatin with experts in pregnancy and diabetes, as well as survey design. The survey included 66 questins t cllect infrmatin n demgraphics (13 questins), diabetes management (8 questins), pregnancy and cntraceptin infrmatin (17 questins), diabetes and pregnancy care (11 questins), knwledge and beliefs (7 questins) as well as pregnancy infrmatin needs and pre-pregnancy reminders ( questins). Knwledge and beliefs questins were adapted with permissin frm published questinnaires. 4,5 The survey was pilt tested with seven wmen with diabetes and feedback prvided by telephne interview. Wh was invited t take part? Wmen registered n the NDSS were invited t cmplete the survey. Pstal invitatins were sent t 6 Australian wmen randmly selected frm the NDSS database wh had type 1 diabetes r type 2 diabetes, had cnsented t be cntacted fr research and were aged 18-5 years. Wmen were sent a letter explaining the purpse f the survey, a plain language statement and a flyer prmting the nline survey (with the ptin f requesting a paper cpy). A reminder pstcard was sent three weeks after the initial invitatin. T prmte the survey, flyers were prvided t Diabetes Australia agents fr display in retail utlets, and were sent t health prfessinal cntacts wh specialised in pregnancy and diabetes. The survey was prmted n scial media and nline diabetes netwrks including Facebk pages f NDSS and Diabetes Australia agents, the Type 1 Diabetes Netwrk Facebk page and website, and the Australian Centre fr Behaviural Research in Diabetes newsletter and website. Abut the results Of the 6 wmen frm the NDSS database invited t participate, a ttal f 967 wmen with type 1 r type 2 diabetes participated. Wh cmpleted the survey? Wmen wh cmpleted the survey were an average age f 34 years. Mst wmen were living with type 1 diabetes (77%), were brn in Australian (81%) and spke English as their main 3

6 language at hme (96%). Wmen frm all states and a variety f different gegraphic areas cmpleted the survey. These results are shwn in Table 1. Table 1: Characteristics f wmen wh cmpleted the survey (n=967) n (%) Type f diabetes Type 1 Type 2 Age grup years years years 45-5 years State/territry New Suth Wales Queensland Victria Western Australia Suth Australia Tasmania Australian Capital Territry Nrthern Territry Gegraphic lcatin Metrplitan Reginal Rural/Remte Cuntry f birth Australia Other Level f educatin N frmal qualificatins Year /11 r equivalent Year 12 r equivalent Certificate, diplma r trade qualificatin University degree r higher Emplyment Wrking full time Wrking part time r casual Maternity leave frm paid wrk Full time hme duties Unemplyed Retired Student 741 (77%) 226 (23%) 142 (15%) 359 (37%) 315 (33%) 15 (16%) 293 (%) 217 (22%) 211 (22%) 117 (12%) 79 (8%) 23 (2%) 22 (2%) 5 (<1%) 539 (56%) 294 (%) 132 (14%) 785 (81%) 181 (19%) 18 (2%) 94 (%) 154 (16%) 1 (31%) 399 (41%) 3 (35%) 284 (29%) 39 (4%) 127 (13%) 61 (6%) 2 (<1%) 66 (7%) 4

7 Percentage (%) 1. Diabetes management and health care Diabetes treatment Mst wmen with type 1 diabetes indicated that they managed their diabetes using insulin injectins (53%) with the remaining (47%) using an insulin pump. Just ver ne quarter (26%) f wmen with type 2 diabetes managed their diabetes with insulin injectins, 76% with diabetes medicatin and 63% with diet and lifestyle. Height and weight Height and weight was self-reprted and bdy mass index (BMI) calculated (weight/height (m 2 )). The average BMI f (nn-pregnant) respndents was 28.7 and 62% f wmen were in the verweight r bese categries (BMI 25 r abve). Diabetes cmplicatins and ther cnditins 54% f wmen reprted having ne r mre diabetes cmplicatin r related health cnditin. Health care Respndents indicated the health prfessinals they had seen in the past 12 mnths fr diabetes management including the frequency f visits. They als indicated the number f visits t their General Practitiner (GP) which were predminately fr diabetes management. Figure 1 shws the different health prfessinals seen by wmen with diabetes in the past 12 mnths fr diabetes management. Figure 1: Health prfessinals seen in the past 12 mnths fr diabetes management (n=967) GP Endcrinlgist Diabetes Educatr Dietitian Health prfessinal 5

8 The average number f visits t a GP in the past 12 mnths was 7 visits (range -), with an average f 3 visits being mainly fr diabetes. Wmen with type 2 diabetes reprted seeing a GP fr diabetes management mre ften (4 visits) than wmen living with type 1 diabetes (2 visits). 2. Pregnancy and cntraceptin infrmatin Precnceptin cunselling Since being diagnsed with diabetes 7% f wmen reprted talking t a health prfessinal abut pregnancy; 79% f wmen with type 1 diabetes and 44% f wmen with type 2 diabetes culd recall having this cnversatin with a health prfessinal. Wmen talked t a number f different health prfessinals abut pregnancy and diabetes including an Endcrinlgist (77%), GP (71%), Diabetes Educatr (53%), Obstetrician (45%), Midwife (21%) and Dietitian (16%). Of wmen wh spke t mre than ne health prfessinal, 76% stated that cnsistent infrmatin and advice was prvided abut pregnancy and diabetes. Fifty nine percent f wmen said they started the cnversatin abut pregnancy and diabetes with a health prfessinal. The type f infrmatin prvided by health prfessinals during these cnversatins is shwn in Figure 2, including whether r nt wmen wuld have liked this infrmatin (if nt prvided). Figure 2: Pregnancy infrmatin prvided by health prfessinals t wmen with diabetes (n=967) Percentage (%) Imprtance f planning fr pregnancy Reasns fr pregnancy planning Hw t plan fr pregnancy Yes N, but I didn't want N, but I wuld have liked Unsure 6

9 Cntraceptin and pre-pregnancy planning advice Frty nine percent f wmen culd recall being advised by a health prfessinal t use sme frm f cntraceptin t prevent an unplanned pregnancy, and 25% reprted being tld this by a partner, family member r friend. Fifty five percent f wmen culd recall being advised by a health prfessinal that they shuld get diabetes specific pre-pregnancy care befre falling pregnant r planning a pregnancy, and 27% reprted being tld this by a partner, family member r friend. These results differed by type f diabetes, as shwn in Figure 3. Figure 3: Cntraceptin and pre-pregnancy care advice by type f diabetes Percentage (%) Cntraceptin advice - health prfessinal (n=935) Cntraceptin advice - ther (n=931) Pre-pregnancy care advice - health prfessinal (n=943) Pre-pregnancy care advice - ther (n=939) Wmen rated their cnfidence in discussing pregnancy and diabetes with a health prfessinal n a scale f ne (nt cnfident at all) t ten (very cnfident). The average cnfidence rating was 8 ut f. 7

10 Pregnancy and diabetes knwledge There were 13 pregnancy and diabetes knwledge questins asked f all wmen, with ne additinal questin fr wmen with type 2 diabetes. Three pssible answers were included true, false and nt sure. The results f the knwledge questins are shwn in the table belw. Table 2: Knwledge abut pregnancy and diabetes amng wmen with diabetes Knwledge questin True r false Answered Crrectly* Wmen with diabetes cannt take the ral cntraceptive pill False 89% Wmen with diabetes have very limited (few) chices f cntraceptin (a) False 81% Wmen with diabetes can have a healthy baby True 96% Wmen with diabetes shuld get diabetes-specific advice frm a health prfessinal befre falling pregnant Wmen with diabetes shuld take the same amunt f flate as all ther wmen during pregnancy (b) True 93% False 24% Bld glucse levels arund the time yu fall pregnant can affect the health f the baby (a) True 72% High bld glucse levels early in pregnancy d nt increase the risk f birth defects (a) False 61% High bld glucse levels early in pregnancy increase the risk f miscarriage (a) True 6% High bld glucse levels early in pregnancy d nt increase the risk f prblems fr False 81% mther (a) High bld glucse levels early in pregnancy d nt increase the risk f prblems fr False 78% baby (a) Wmen with diabetes have an increased risk f having a large baby, making delivery mre difficult True 82% Wmen with diabetes are recmmended t breastfeed True 48% * Remaining respnses were either incrrect r unsure (a) Questin adapted frm Charrn-Prchwnik et al. 6; (b) Questin adapted frm Hlmes et al. 12. Bld answers are crrect. 8

11 Percentage (%) Wmen with type 2 diabetes were asked an additinal knwledge questin abut whether r nt they may need t change t insulin when planning a pregnancy. Thirty eight percent (38%) f wmen answered this questin crrectly. Wmen were asked abut the recmmended HbA1c level befre pregnancy in a separate questin. These results are shwn belw. Figure 4: HbA1c targets fr pregnancy in wmen with diabetes (n=927) % 7% 8% Unsure HbA1c Wmen were asked t rate their understanding abut hw diabetes and pregnancy affect as scre ut f (pr t excellent). 38% percent f wmen rated their knwledge as high (scres 8 ut f and abve). 9

12 3. Pregnancy and diabetes Six percent f wmen were pregnant at the time f cmpleting the survey. Of wmen wh were nt currently pregnant 19% were thinking abut planning a pregnancy, 8% were trying t fall pregnant and 73% were nt planning a pregnancy r trying t fall pregnant. Pre-pregnancy care Of wmen wh had been pregnant since being diagnsed with type 1 r type 2 diabetes, were currently pregnant r trying t fall pregnant 54% reprted having attended pre-pregnancy care. The reasns reprted fr nt attending pre-pregnancy care are shwn in the table belw. Table 3: Reasns fr nt attending pre-pregnancy care Reasn I didn t knw pre-pregnancy care was available 48% My pregnancy was nt planned 47% I already knew what I needed t d 19% I fell pregnant sner than expected 18% Practical barriers (e.g. time, cst, childcare) % N services were available in my area 8% Didn t have access t diabetes health prfessinals I felt cmfrtable with 6% Didn t want a pregnancy that was different frm wmen withut diabetes 6% Negative experiences when discussing this tpic with health prfessinals 6% T difficult t get my BGLs int target range fr pregnancy 4% Wrried r afraid f what I might learn abut pregnancy and diabetes 3% Des nt tally t % due t multiple respnse categries Wmen wh had previusly attended pre-pregnancy care were asked t rate hw helpful this was n a scale f ne (nt helpful at all) t ten (extremely helpful). The average rating was 8, with 68% f wmen rating the helpfulness f pre-pregnancy care as 8 ut f r abve. Wmen were asked if they wuld be likely t discuss any future pregnancy plans with a health prfessinal befre trying t fall pregnant. Sixty three percent (63%) said they wuld discuss these plans with a health prfessinal, 3% said that they wuld nt discuss and 3% were unsure. The remaining 31% f wmen said that this did nt apply t them as they were nt planning any pregnancies in the future.

13 Wmen with type 1 diabetes were mst likely t discuss pregnancy plans with an endcrinlgist (65%), while wmen with type 2 diabetes wuld be mre likely have these discussins with a General Practitiner (44%). Cnfidence in the knwledge f the health prfessinal they wuld be mst likely t speak with abut pregnancy was rated frm ne (nt cnfident at all) t ten (extremely cnfident). The average rating f cnfidence in health prfessinals was 8 ut f. Wmen were asked if pre-pregnancy care was available thrugh their lcal diabetes service, cmmunity health centre, hspital r endcrinlgist. One third f wmen (33%) said that diabetes pre-pregnancy care was available, 5% said that this was nt available and 61% were unsure if this was available. 89% f wmen said they wuld attend their lcal service if prepregnancy care was available, 4% said they wuld nt attend and 7% were unsure if they wuld attend. Reasns why wmen wuld nt attend pre-pregnancy care included already knwing what they need t d (44%), nt having a health prfessinal at their lcal service that they feel cmfrtable with (16%) and ther reasns (33%) the main ne being that they had previusly attended anther service and wuld access this care again rather than seek ut lcal services. 4. Beliefs abut pregnancy and cntraceptin Wmen s views and beliefs abut pregnancy and diabetes were examined in a series f questins which included measures f precnceptin planning behaviurs adapted with permissin frm the RHAB questinnaire []. Risk perceptins were als examined in tw separate questins in this sectin f the survey. Selected results are presented in this reprt. Wmen were asked t rate hw much they wrry abut the ptential fr health prblems using a scale frm ne (nt at all) t five (a lt). These results are shwn by type f diabetes in Figures 5 and 6. 11

14 Percentage (%) Percentage (%) Figure 5: Hw much d yu wrry that yu culd develp health prblems during pregnancy? (n=625) Nt at all A little Smewhat A mderate amunt A lt Figure 6: Hw much d yu wrry that yur baby culd develp health prblems during yur pregnancy? (n=623) Nt at all A little Smewhat A mderate amunt A lt 12

15 Percentage (%) Percentage (%) Wmen were asked t rate the seriusness f health prblems using a scale frm ne (nt serius at all) t five (very serius). These results are shwn by type f diabetes in Figures 7, 8 and 9. Figure 7: If yu develped health prblems during pregnancy, hw serius d yu think thse health prblems wuld be? (n=6) Nt serius at all A little serius Smewhat serius Mderately serius Very serius Figure 8: If yur baby develped health prblems during pregnancy, hw serius d yu think thse health prblems wuld be? (n=618) Nt serius at all A little serius Smewhat serius Mderately serius Very serius 13

16 Percentage (%) Percentage (%) Figure 9: If yu had an unplanned pregnancy, d yu think this culd cause health prblems fr yu r the baby? (n=624) Nt at all A little Smewhat A mderate amunt A lt Wmen were asked t rate using a scale frm ne (nt at all) t five (a lt) hw much they believed these preventive health measures wuld imprve pregnancy utcmes. These results are shwn by type f diabetes in Figures, 11 and 12. Figure : Wuld using cntraceptin prevent an unplanned pregnancy? (n=623) Nt at all A little Smewhat A mderate amunt A lt 14

17 Percentage (%) Percentage (%) Figure 11: Wuld getting pre-pregnancy care (specialist diabetes medical care and advice) when planning a pregnancy imprve yur chances f having a healthy baby? (n=623) Nt at all A little Smewhat A mderate amunt A lt Figure 12: Wuld having bld glucse levels in the target range befre becming pregnant imprve yur chances f having a healthy baby? (n=623) Nt at all A little Smewhat A mderate amunt A lt 15

18 Percentage (%) Percentage (%) Wmen were asked t rate the difficulty f getting and fllwing pre-pregnancy care using a scale frm ne (nt difficult at all) t five (very difficult). These results are shwn by type f diabetes in Figure 13. Figure 13: Hw difficult wuld it be t fllw pre-pregnancy care (specialist diabetes medical care and advice) when planning a pregnancy? (e.g. keeping bld glucse levels within the target range, adjusting insulin dses) (n=617) Des nt apply Nt difficult at all A little difficult Smewhat difficult Mderately difficult Very difficult Wmen were asked abut what they believed wuld be the benefits f seeking prepregnancy care. Wmen rated the questin n a scale frm ne (nt at all) t five (a lt). These results are shwn belw. Figure 14: Wuld yu say that getting pre-pregnancy care wuld help yu get yur bld glucse levels in the target range? (n=614) Nt at all A little Smewhat A mderate amunt A lt 16

19 Percentage (%) Percemntage (%) Seventy seven percent (77%) f wmen believed that they were at mderate r high risk fr develping health prblems related t diabetes during pregnancy and 36% believed that their risk f health prblems during pregnancy was much higher than wmen withut diabetes as shwn in figures 15 and 16. Figure 15: What d yu believe yur risk is fr develping health prblems related t diabetes during pregnancy? (n=627) 6 5 Almst n risk Slight risk Mderate risk High risk Dn't knw / haven't thught abut Figure 16: What d yu believe yur risk f develping health prblems during pregnancy is cmpared t ther wmen f yur age wh dn t have diabetes? (n=57) Much lwer Smewhat lwer Same Smehwat higher Much higher 17

20 5. Pregnancy and diabetes infrmatin Wmen were asked a series f questins abut the type f infrmatin they wuld like abut cntraceptin, pregnancy and wmen s health and hw they wuld like t receive this infrmatin. Questins were als asked t determine if wmen with diabetes believed there wuld be a benefit in being reminded abut planning and preparing fr pregnancy, preferred frequency and methd fr receiving reminders. Infrmatin needs The infrmatin that wmen wuld like abut pregnancy and diabetes either nw r in the future are shwn in Table 4 belw. Table 4: Pregnancy and diabetes infrmatin needs Tpic Hw t manage my diabetes during pregnancy 7% Risks r cmplicatins fr my baby 65% Hw t manage my diabetes t prepare fr pregnancy 64% Risks r cmplicatins related t pregnancy 61% Medicatins r insulin changes during pregnancy 59% Diabetes pre-pregnancy services available in my area 49% Breastfeeding and diabetes 47% Diabetes and fertility 45% Hw t manage my diabetes after childbirth 44% Nutritin and exercise during pregnancy 37% Labur and birth 34% Mds and emtins related t pregnancy and childbirth 23% Cntraceptin 22% Other 3% 18

21 When asked hw they wuld like t receive infrmatin abut pregnancy and diabetes, wmen indicated their preferred surces f infrmatin as shwn in Table 5. Table 5: Preferred surce f pregnancy and diabetes infrmatin Surce f infrmatin One-n-ne advice frm a health prfessinal 79% A pregnancy and diabetes infrmatin seminar r webinar 41% Pamphlets, bklets r written infrmatin frm NDSS r agent % Internet/web-based infrmatin % Pamphlets, bklets r written infrmatin prvided by a health prfessinal 34% Grup educatin sessins with a health prfessinal 26% DVD 8% Smart phne app % Other 2% Eighty ne percent f wmen reprted that they wuld use r have previusly used the internet t search fr infrmatin abut cntraceptin, pregnancy and diabetes. When these wmen were asked abut preferred frmat fr accessing web based infrmatin 92% f preferred dwnladable fact sheets, 27% blgs, 26% nline frums, 22% scial media, 21% nline vide clips with infrmatin frm a health prfessinal, 19% nline vide clips with infrmatin frm a wmen with diabetes and 3% ther frmat. NDSS resurces Wmen were asked abut use f the existing NDSS Can I have a healthy baby? Bklet and DVD. Twenty eight percent f wmen had read the NDSS bklet, 67% had nt read the bklet and 6% were unsure. Eight percent f wmen had watched the DVD, 89% had nt seen the DVD and 3% were unsure. Pregnancy reminders When asked abut whether they wuld see a benefit in receiving regular reminders abut planning and preparing fr pregnancy, 36% f wmen agreed, 14% disagreed and 12% were unsure. Thirty nine said that this wuld nt apply t them as they were nt planning any pregnancy in the future. Of thse wh wanted t receive reminders, the preferred frequency was annual reminders (73%), with fewer wmen wanting reminders every secnd year (19%) and 8% wanting reminders at an ther time, including quarterly, every six mnths r every 3-5 years. Wmen wh wanted t receive reminders were asked t nminate their preferred surce fr receiving this infrmatin. Sme differences were nted in the preferred surce f pregnancy planning reminders by type f diabetes. Wmen with type 1 diabetes were mre likely t prefer 19

22 a reminder frm a diabetes health prfessinal than wmen with type 2 diabetes (53% vs. %), while wmen with type 2 diabetes were mre likely t prefer a reminder frm a GP (35% vs. 21%) r an electrnic reminder frm the NDSS (54% vs. 38%). When asked if they wuld like t receive general health r wmen s health infrmatin frm the NDSS, the majrity f wmen (79%) were happy t receive this type f infrmatin, 14% did nt want this infrmatin frm the NDSS and 7% were unsure. A summary f the results This is the first Australian survey investigating the knwledge, barriers, attitudes, beliefs and infrmatin needs f wmen with diabetes in relatin t cntraceptin and pregnancy. Key findings frm this survey are summarised belw: The majrity f wmen had discussed pregnancy and diabetes with a health prfessinal. These results varied by type f diabetes, with less wmen with type 2 diabetes reprting having this cnversatin with a health prfessinal. Diabetes health prfessinals (Endcrinlgists and Diabetes Educatrs) and GPs were the health prfessinals with whm pregnancy and diabetes was mst frequently discussed. Wmen reprted that they were mst likely t initiate the cnversatin abut pregnancy and diabetes. The imprtance f planning fr pregnancy was discussed mst frequently, fllwed by reasns fr planning. Hw t plan fr pregnancy was less likely t be discussed. Apprximately half f all wmen wh did nt receive infrmatin n planning and preparing fr pregnancy wuld have liked this infrmatin. Apprximately ne quarter f wmen reprted that the infrmatin they received abut pregnancy and diabetes differed between health prfessinals. Wmen with type 2 diabetes were less likely t recall receiving advice abut cntraceptin and the need fr pre-pregnancy care frm a health prfessinal. The main gaps in knwledge fr wmen with diabetes were the need fr high dse flate, breastfeeding recmmendatins and understanding f the risks assciated with high bld glucse levels in early pregnancy (miscarriage and birth defects). Mst wmen identified the target HbA1c prir t pregnancy as 6% r 7% (r less). Many wmen were unsure f the recmmended target HbA1c. Wmen with type 1 and type 2 diabetes were likely t seek advice frm different health prfessinals in regards t pregnancy and diabetes. A lack f awareness abut pre-pregnancy planning services and unplanned pregnancies were the majr reasns given by wmen fr nt attending pre-pregnancy care. Awareness abut the availability f pre-pregnancy care at lcal services was limited. Less than half f all wmen rated the risk f health prblems fr the baby assciated with unplanned pregnancy as mderate r a lt. The majrity f wmen believed that they were mderate r high risk fr develping health prblems related t diabetes during pregnancy.

23 Just ver ne third believed that their risk f health prblems during pregnancy was much higher than wmen withut diabetes. The benefit f cntraceptin t prevent unplanned pregnancy, having bld glucse levels in the target range and pre-pregnancy care imprving the chances f having a healthy baby were recgnised by mst wmen. Wmen reprted that they wuld prefer receiving infrmatin ne n ne frm a health prfessinal, in additin t pamphlets and bklets prvided by a health prfessinal, NDSS r Diabetes Australia agents, seminars/webinars and the internet. The infrmatin wmen with diabetes were mst interested in were related t risks during pregnancy and risks fr the baby, as well as diabetes management befre and during pregnancy. The majrity f wmen did nt see a benefit in receiving regular reminders abut planning and preparing fr pregnancy. Of thse wh did wish t be reminded, a reminder frm NDSS r a diabetes health prfessinal were preferred. Mst wmen were happy t receive general diabetes management infrmatin r wmen s health infrmatin frm the NDSS. Next steps Based n the key findings frm survey and cnsultatin with health prfessinals, a number f strategies have been develped fr the NDSS Diabetes in Pregnancy NDP t imprve access t infrmatin abut pregnancy and diabetes fr wmen and their health care prfessinals. These include strategies t plan and develp: Resurces n pregnancy and diabetes, including a website, bklets and pregnancy planning fact sheets fr wmen with type 1 and type 2 diabetes Pregnancy and diabetes seminar/webinar package Cntinuing prfessinal develpment fr health prfessinals Strategies fr reminding wmen with diabetes f the need t plan and prepare fr pregnancy The findings f the NDSS Cntraceptin, Pregnancy & Wmen s Health Survey can als prvide further guidance fr the develpment f future NDSS activities. 21

24 References 1. AIHW. Diabetes in pregnancy: its impact n Australian wmen and their babies. Diabetes series n.14. Cat. n. CVD 52. Canberra: AIHW. 2. Murphy HR, Rland JM, Skinner TC, Simmns D, Gurnell E, Mrish NJ, S S-C, Kelly S, Randall J, Tmpsett S, and Temple RC. Effectiveness f a reginal pre-pregnancy care prgram in wmen with type 1 and type 2 diabetes: benefits beynd glycemic cntrl. Diabetes Care ; 33: McElduff, A., et al., The Australasian Diabetes in Pregnancy Sciety cnsensus guidelines fr the management f type 1 and type 2 diabetes in relatin t pregnancy. Med J Aust, (7): p Natinal Health and Medical Research Cuncil, Natinal Evidence-Based Clinical Care Guidelines fr Type 1 Diabetes fr Children, Adlescents and Adults 11: Canberra,. 5. American Diabetes Assciatin, Precnceptin care f wmen with diabetes. Diabetes Care, 4. 27(Suppl 1): p. S Natinal Institute fr Health and Care Excellence, Diabetes in pregnancy: Management f diabetes and it's cmplicatins frm precnceptin t the pstnatal perid., 8, Natinal Institute fr Health and Care Excellence,: Lndn 7. Ray, J., T. O'Brien, and W. Chan, Precnceptin care and the risk f cngenital anmalies in the ffspring f wmen with diabetes mellitus: a meta-analysis. QJM, 1. 94(8): p Wahabi, H., et al., Precnceptin care fr diabetic wmen fr imprving maternal and fetal utcmes: a systematic review and meta-analysis. BMC Pregnancy Childbirth,. :63(di): p..1186/ McElduff, A., et al., Pregestatinal diabetes and pregnancy: an Australian experience. Diabetes Care, 5. 28(5): p Charrn-Prchwnik, D., et al., A thery-based reprductive health and diabetes instrument. Am J Health Behav, 6. (2): p Hlmes, V., et al., Evaluatin f a DVD fr wmen with diabetes: impact n knwledge and attitudes t precnceptin care. Diabet Med, (7): p Acknwledgments: Survey questins adapted frm the Reprductive Health Attitudes and Behavir instrument. Charrn- Prchwnik et al, American Jurnal f Health Behaviur 6; (2): 8 2 and Hlmes et al Diabetic Medicine 12 29:

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