Objective: Unplanned pregnancies among young women with diabetes are associated with hyperglycaemia related fetopathy. We have evaluated whether introducing a structured approach to contraception and pregnancy planning in the clinic was associated with greater uptake of contraception and reduced pregnancy rates.
Methods: Repeat retrospective reviews before (2012-2016) and after (2017- 2018) the introduction of a proforma including documentation of contraception uptake, provision of educational materials, reserved waiting area space and early evening clinic slots in a tertiary hospital diabetes transition clinic (for those aged 17-25 years). Between clinic telephone support continued unchanged.
Results: The pre-/post-change reviews included 43 and 48 women with type 1 diabetes (T1DM) respectively. Age at diagnosis (10-11 years), time between first and last clinic attendance (25-26 months), diabetes duration (10-12 years), CSII use (23%) and HbA1c (9.5-9.7%) on first attendance were similar. Number of clinic attendances dropped from 6.8±4.1 to 5.0±3.7 (p=0.01). HbA1c reduction since first attendance (0.1±1.8 vs. 1.2±3.0%, p<0.001) was greater, and episodes of diabetic ketoacidosis (55.8% vs. 14.6% p<0.001) and severe hypoglycaemia (18.6% vs. 2.1% 0.01) were less, in the ‘after’ group. Metformin use increased from 2.3% to 18.4% (p<0.05). Use of CGMS increased from 0% to 39.6% (p<0.001). Documented advice on contraception increased from 0% to 95.8% (p<0.001). Use of contraception increased from 25.6% to 43.8% (p<0.001: implants 7 to 15%, OCPs 16 to 27%). Prior/current pregnancy rates were less (18.6% vs. 8.3% respectively; p=0.03).
Conclusions: Introduction of more proactive approaches to diabetes management including contraception awareness and advice were associated with improved glycaemia and a reduced risk of pregnancy in younger women with T1DM.
D. Simmons: Speaker's Bureau; Self; Sanofi-Aventis. Other Relationship; Self; Medtronic. U.L. Osuagwu: None. A. Gupta: None. M. Ratnaweera: None.
