Planning for pregnancy: why some women with diabetes do (not) attend pre-pregnancy care

ACBRD researchers collaborated with Diabetes NSW/ACT on a study examining factors associated with uptake of pre-pregnancy care among women with diabetes. 

by Jasmine Schipp and Dr Christel Hendrieckx

Women with type 1 and type 2 diabetes have an increased risk of birth defects and miscarriage during pregnancy. Our previous review has highlighted that these risks can be reduced with pre-pregnancy care, which involves seeing a health professional before conception to prepare for pregnancy. While pre-pregnancy care has proven benefits and is recommended for all women with pre-existing diabetes, many do not plan their pregnancies or attend pre-pregnancy care. Currently, little is known about the reasons for this. Together with colleagues from the NDSS Pregnancy & Diabetes National Priority Area (led by Diabetes NSW/ACT and a multidisciplinary expert group), ACBRD researchers conducted a study to better understand the reasons why women do and do not attend pre-pregnancy care.

This study was part of a larger Australian survey among women with diabetes aged 18 to 50 years. For this study, a subsample of 429 women with diabetes (type 1 = 364, type 2 = 65) who had been pregnant, were currently pregnant or trying to become pregnant completed a survey on pre-pregnancy care. Women who reported that they had not attended an appointment with a diabetes health professional to prepare for pregnancy were asked to select their main reasons for not attending from a list of 15 options.

Around half (54%) of those surveyed reported having attended pre-pregnancy care. Women with type 1 diabetes were more likely to attend pre-pregnancy care than those with type 2 diabetes. In addition, women who were university educated, married (or defacto), or employed were also more likely to attend pre-pregnancy care. The main reasons for not attending pre-pregnancy care were that they did not know it was available (48%) and that the pregnancy was unplanned (47%). Only 20% indicated that they did not attend pre-pregnancy care as they already knew what to do. Of women with future pregnancy plans, only 43% were aware of local pre-pregnancy care services but 84% indicated that they would attend if it was available.

These findings indicate that strategies are needed to raise awareness of pre-pregnancy care services, promoting them as an opportunity to address any worries/concerns and creating positive messaging about the benefits of planning for a healthy pregnancy. They also highlight the need to promote effective contraception use to minimise unplanned pregnancy in women with diabetes.

Morrison M, Hendrieckx C, Nankervis A, Audehm R, Farrell K, Houvardas E, Scibilia R & Ross GP. Factors associated with attendance for pre-pregnancy care and reasons for non-attendance among women with diabetes. Diabetes Research and Clinical Practice, 2018; 142: 269-275.

Did you know?

68% of women with diabetes rated attending pre-pregnancy care as helpful.

54% of women with diabetes reported having ever attended pre-pregnancy care.

The main reasons women with diabetes reported that did not attend pre-pregnancy care were that they did not know it was available (48%) and that the pregnancy was unplanned (47%).

To read more of our research on diabetes and pregnancy, check out our previous blog on this topic: