Preconception Counseling: Frequently Forgotten by Primary Care Providers due to Multiple Barriers

Presentation Number: SAT-724
Date of Presentation: March 17, 2018, 2018

Angela Manglitz, DO1, Sandhya Venkataraman, D.O2, Melissa Dion, MD1, Gretchen Anne Perilli, MD1, Marc A. Vengrove, DO,FACP1.
1Lehigh Valley Health Network, Allentown, PA, USA, 2Lehigh Valley Hospital - Cedar Crest, Allentown, PA, USA.

Abstract

Preconception counseling (PC) is defined as organized care specifically targeted for women with diabetes mellitus (DM) that are preparing for pregnancy with the main goal of optimizing their glycemic control prior to conception. The American Diabetes Association (ADA) recommends that all women of childbearing age with DM receive PC beginning at puberty. The primary objective of our study was to estimate the percentage of women 18-35 years old with type 1 or type 2 DM who received PC from primary care providers: family medicine (FM), internal medicine (IM), and obstetrics and gynecology (OB) physicians in Lehigh Valley Health Network (LVHN). The secondary objective was to create a survey to determine barriers preventing health care providers from providing PC. Patient population included women ages 18-35 with type 1 or type 2 DM with or without complications that had a non-acute office visit with FM, IM, or OB between June 1, 2014 and June 30, 2016. Office notes were reviewed to determine if the patient received PC at the office visit. 577 charts met specific criteria for analysis. Since there are sparse data exploring perceived provider barriers to PC, a survey was created and sent electronically to FM, IM, and OB providers. Of the 524 surveys emailed to providers, 97 surveys were completed (18.5%). For the primary objective, 109 patients (18.9%) received PC during an office visit in the past 3 years. There was a statistically significant association between specialty and PC: OB visits had a higher proportion of women who received PC (36.1%) compared to FM (7.11%) and IM (9.82%). The overall survey responses revealed that providers would like more time during an appointment to discuss PC and another appointment to discuss PC. In addition, they felt that unplanned pregnancies are a barrier and that women should ask for PC. In conclusion, the rate of PC provided at LVHN does not meet the ADA guidelines. OB provided the most PC at LVHN, which may be due to their patient population being females of childbearing age. Based on survey responses, providers believe they are supplying PC more regularly than they are. Furthermore, providers would be more likely to provide PC if women initiated the discussion and if they had more time. Educating providers on the need to initiate and incorporate PC discussions in an efficient manner during routine visits may improve the rates of PC in women with pre-existing DM.

Disclosures

 A. Manglitz: None. S. Venkataraman: None. M. Dion: None. G.A. Perilli: None. M.A. Vengrove: None.