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Ren M, Shireman H, VanGompel EW, Bello JK, Carlock F, McHugh A, Stulberg D. Preconception, Interconception, and reproductive health screening tools: A systematic review. Health Serv Res 2023; 58:458-488. [PMID: 36573542 PMCID: PMC10012234 DOI: 10.1111/1475-6773.14123] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To identify and describe the standardized interconception and preconception screening tools for reproductive health needs that are applicable in general outpatient clinical practice. DATA SOURCES AND STUDY SETTING This systematic review identifies research on pregnancy intention screening and counseling tools, and standardized approaches to preconception and interconception care. We focus on tools designed for clinical settings, but also include research tools with potential for clinical implementation. These tools may include a component of contraceptive counseling, but those focusing solely on contraceptive counseling were excluded. Data were collected from studies done in the United States between January 2000 and March 2022. STUDY DESIGN We performed a systematic literature search to generate a list of unique tools, assessed the quality of evidence supporting each tool, and described the peer-reviewed clinical applications of each. We used the Mixed Methods Appraisal Tool to appraise the quality of individual studies. DATA COLLECTION/EXTRACTION METHODS We searched PubMed, Web of Science, and CINAHL databases for standardized preconception and interconception health screening tools published in English from January 2000 through March 2022. We used keywords "preconception care," "interconception care," "family planning," "contraception," "reproductive health services," and "counseling." Utilizing the Preferred Reporting Items for Systematic Reviews guidelines, we screened titles and abstracts to identify studies for full text review. PRINCIPAL FINDINGS The search resulted in 15,399 studies. After removing 4172 duplicates, we screened 11,227 titles/abstracts and advanced 207 for full-text review. From these, we identified 53 eligible studies representing 22 tools/standardized approaches, of which 10 had evidence from randomized clinical trials. These ranged widely in design, setting, and population of study. CONCLUSIONS Clinicians have a choice of tools when implementing standard reproductive screening services. A growing body of research can inform the selection of an appropriate tool, and more study is needed to establish effects on long-term patient outcomes.
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Affiliation(s)
- Megan Ren
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Hannah Shireman
- Department of Family Medicine, University of Chicago, Chicago, Illinois, USA
| | - Emily White VanGompel
- Department of Family Medicine, University of Chicago, Chicago, Illinois, USA.,Northshore University Healthsystem, Evanston, Illinois, USA
| | - Jennifer K Bello
- Department of Family and Community Medicine, Saint Louis University, St Louis, Missouri, USA
| | | | - Ashley McHugh
- Department of Family Medicine, University of Chicago, Chicago, Illinois, USA
| | - Debra Stulberg
- Department of Family Medicine, University of Chicago, Chicago, Illinois, USA
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2
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Gerhardt CR, Pulz GTC, Satler F, Leitão CB. Contraception in women with diabetes: adequacy of medical files registration and prescription - a cross-section study. Endocrine 2023; 80:511-519. [PMID: 36914829 PMCID: PMC10010636 DOI: 10.1007/s12020-023-03344-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/26/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To describe the adequacy of diabetes mellitus (DM) patient's files registry regarding contraception method (CM), factors associated with lack of registry, and if prescription is in accordance with World Health Organization (WHO) eligibility criteria. RESEARCH DESIGN AND METHODS This cross-sectional study was developed in two phases: (1) electronic medical records of women with DM who attended the outpatient clinic of a university hospital were reviewed to identify women in reproductive age and to look for CM registration and (2) interviews regarding contraception use, comorbidities and chronic DM complications. RESULTS Among 1069 files analyzed, 313 women with DM in childbearing age were identified. Out of those, 55.3% had a CM registered. Age >40 years, non-white skin color, and ≤11 years of education were associated with no registration. Of the 270 women interviewed, 201 (74.4%) were using CM. Out of the 69 patients not on CM, 51 fertile patients were at risk of an unplanned pregnancy (18.8% of the sample). The most frequently used method was oral hormonal (combined: 34.3%; progestin-only: 17.9%), and 67 (33.3%) were using an inadequate method (WHO eligibility category 3/4). CONCLUSION One third of women with DM are in childbearing age. Older age, non-white skin color, and lower education level were associated with lack of CM registration. One-third of respondents were using CM inappropriate for their clinical condition and one-fifth were at risk for an unplanned pregnancy. So, improvements in family planning for women with DM should be instituted.
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Affiliation(s)
- Caroline R Gerhardt
- Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
- Universidade do Vale do Taquari (UNIVATES), Lajeado, Brazil.
| | - Geórgia T C Pulz
- Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Fabíola Satler
- Endocrine Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Cristiane B Leitão
- Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Endocrine Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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3
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Ferry P, Dunne FP, Meagher C, Lennon R, Egan AM, Newman C. Attendance at pre-pregnancy care clinics for women with type 1 diabetes: A scoping review. Diabet Med 2023; 40:e15014. [PMID: 36408687 PMCID: PMC10099966 DOI: 10.1111/dme.15014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Type 1 diabetes mellitus occurs in one in every 275 pregnancies and can result in increased morbidity and mortality for both mother and baby. Several pregnancy complications can be reduced or prevented by attendance at pre-pregnancy care (PPC). Despite this, less than 40% of pregnant women with pre-gestational diabetes receive formal PPC. The aim of this scoping review is to identify the barriers to PPC attendance among women with type 1 diabetes. METHODS We conducted a scoping review by searching five databases (Ebsco, Embase, Ovid and PubMed for literature and the ProQuest for any grey/unpublished literature) for studies in English between 2000 and 2022. Studies that evaluated attendance at PPC for women with type 1 diabetes were included. RESULTS There are multiple barriers to PPC attendance, and many of these barriers have been unchanged since the 1990s. Identified barriers can be grouped under patient-centered and clinician-centered headings. Patient factors include knowledge and awareness, unplanned pregnancies, negative perceptions of healthcare and communication issues, unclear attendance pathways and logistical issues including time off work and childcare. Clinician factors include physician knowledge, time constraints and lack of comfort discussing pregnancy/contraception. CONCLUSION This review highlights the ongoing problem of poor attendance at PPC and identifies key barriers to be addressed when developing and implementing PPC programs for women with type 1 diabetes.
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Affiliation(s)
- Pauline Ferry
- School of Nursing and MidwiferyNational University of IrelandGalwayIreland
- Women and Infants' ServicesLetterkenny University HospitalDonegalIreland
| | - Fidelma P. Dunne
- School of MedicineNational University of IrelandGalwayIreland
- Department of Diabetes and EndocrinologyGalway University HospitalGalwayIreland
| | - Catherine Meagher
- School of Nursing and MidwiferyNational University of IrelandGalwayIreland
| | - Roisin Lennon
- Advanced Nurse Practitioner, Women and Infants' ServicesSligo University HospitalGalwayIreland
| | - Aoife M. Egan
- Division of EndocrinologyMayo ClinicRochesterMinnesotaUSA
| | - Christine Newman
- School of MedicineNational University of IrelandGalwayIreland
- Department of Diabetes and EndocrinologyGalway University HospitalGalwayIreland
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D'Amico RP, Pian TM, Buschur EO. Transition From Pediatric to Adult Care for Individuals With Type 1 Diabetes: Opportunities and Challenges. Endocr Pract 2022; 29:279-285. [PMID: 36528273 DOI: 10.1016/j.eprac.2022.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Type 1 diabetes (T1D) is a chronic disease with patients across the age spectrum that has high potential for morbidity and mortality. Unfortunately, patients transitioning from pediatric to adult care continue to demonstrate worsened glycemic control in part due to lack of understanding of transition of care best practices. METHODS This review highlights the impact of existing transition of care interventions, assessment tools, and other recently published strategies for providers to consider to improve care of adolescent and young adult (AYA) patients with T1D in both hospital- and clinic-based settings. RESULTS Many barriers impact patients with T1D during the transition period and disparities by race, sex, insurance status, and comorbid illness persist. As diabetic care continues to evolve and the prevalence of adolescents and young adults living with T1D increases, an intentional approach to transition of care is more pressing than ever. While current literature on transition of care models is limited, many show promise in improving clinic attendance and decreasing hospitalization. There are critical discussions that providers should lead with AYA patients to improve their outcomes and increase diabetes self-management, such as re-addressing carbohydrate counseling, sleep hygiene, and reproductive planning. CONCLUSION While further research on transition of care is needed, many care models offer the promise of improved T1D outcomes, enhancements in our approach to care, and increased value for our health care system at large.
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Affiliation(s)
- Rachel P D'Amico
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Timothy M Pian
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Elizabeth O Buschur
- Division of Endocrinology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio.
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Gregory JW, Cameron FJ, Joshi K, Eiswirth M, Garrett C, Garvey K, Agarwal S, Codner E. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes in adolescence. Pediatr Diabetes 2022; 23:857-871. [PMID: 36250644 PMCID: PMC9828225 DOI: 10.1111/pedi.13408] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- John W. Gregory
- Division of Population Medicine, School of MedicineCardiff UniversityCardiffUK
| | - Fergus J. Cameron
- Royal Children's HospitalMelbourneAustralia,Murdoch Children's Research InstituteMelbourneAustralia,Department of PaediatricsUniversity of MelbourneMelbourneAustralia
| | - Kriti Joshi
- Department of Endocrinology & DiabetesQueensland Children's HospitalSouth BrisbaneAustralia
| | - Mirjam Eiswirth
- Department of Anglophone StudiesUniversität Duisburg EssenEssenGermany
| | - Christopher Garrett
- Institute of Psychiatry, Psychology and NeuroscienceBart's Health and East London Foundation TrustLondonUK
| | - Katharine Garvey
- Division of EndocrinologyBoston Children's HospitalBostonMassachusettsUSA
| | - Shivani Agarwal
- Department of Medicine (Endocrinology), Albert Einstein College of MedicineMontefiore Medical CenterBronxNew YorkUSA
| | - Ethel Codner
- Instituto de Investigaciones Materno Infantil, Facultad de MedicinaUniversity of ChileSantiagoChile
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Roberts AJ, Sauder K, Stafford JM, Malik FS, Pihoker C, Boghossian NS, Ehrlich S, Pettitt DJ, Dabelea D, Bellatorre A, D’Agostino R, Jensen ET. Preconception Counseling in Women With Diabetes: The SEARCH for Diabetes in Youth Study. Clin Diabetes 2022; 41:177-184. [PMID: 37092149 PMCID: PMC10115614 DOI: 10.2337/cd22-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Preconception counseling is recommended for all women with diabetes starting at puberty to convey the importance of optimal diabetes management for maternal and fetal outcomes. This study included 622 female participants from the SEARCH for Diabetes in Youth study with a mean age of 22.2 years (range 14-35 years). Only 53.7% reported ever receiving preconception counseling, which was significantly lower among women seeing pediatric providers than those seeing adult or all-age providers. Older age and history of prior pregnancy were associated with increased odds of reporting having received preconception counseling. Identification of barriers to delivering preconception counseling to young females with diabetes and strategies to overcome them are needed to reduce the risk for pregnancy complications and adverse offspring health outcomes.
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Affiliation(s)
| | - Katherine Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO
| | - Jeanette M. Stafford
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Faisal S. Malik
- Department of Pediatrics, University of Washington, Seattle, WA
| | | | - Nansi S. Boghossian
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Shelley Ehrlich
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO
| | - Anna Bellatorre
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO
| | - Ralph D’Agostino
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Elizabeth T. Jensen
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
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Schäfer-Graf U, Seifert-Klauss V. Typ-1-Diabetes – besondere Herausforderungen für Frauen. DIABETOLOGE 2022. [DOI: 10.1007/s11428-022-00857-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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8
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Nwolise CH, Carey N, Shawe J. Preconception and Diabetes Information (PADI) App for Women with Pregestational Diabetes: a Feasibility and Acceptability Study. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2021; 5:446-473. [PMID: 35415455 PMCID: PMC8982818 DOI: 10.1007/s41666-021-00104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 03/07/2021] [Accepted: 05/11/2021] [Indexed: 11/28/2022]
Abstract
Diabetes mellitus increases the risk of adverse maternal and fetal outcomes. Preconception care is vital to minimise complications; however, preconception care service provision is hindered by inadequate knowledge, resources and care fragmentation. Mobile health technology, particularly smartphone apps, could improve preconception care and pregnancy outcomes for women with diabetes. The aim of this study is to co-create a preconception and diabetes information app with healthcare professionals and women with diabetes and explore the feasibility, acceptability and preliminary effects of the app. A mixed-methods study design employing questionnaires and semi-structured interviews was used to assess preliminary outcome estimates (preconception care knowledge, attitudes and behaviours), and user acceptability. Data analysis included thematic analysis, descriptive statistics and non-parametric tests. Improvements were recorded in knowledge and attitudes to preconception care and patient activation measure following the 3-month app usage. Participants found the app acceptable (satisfaction rating was 72%), useful and informative. The app's usability and usefulness facilitated usage while manual data input and competing priorities were barriers which participants felt could be overcome via personalisation, automation and use of daily reminders. This is the first study to explore the acceptability and feasibility of a preconception and diabetes information app for women with diabetes. Triangulated data suggest that the app has potential to improve preconception care knowledge, attitudes and behaviours. However, in order for women with DM to realise the full potential of the app intervention, particularly improved maternal and fetal outcomes, further development and evaluation is required.
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Affiliation(s)
- Chidiebere H Nwolise
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, L1/16 Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Nicola Carey
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Jill Shawe
- School of Nursing & Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
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9
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Giraudo F, Lalanne I, Valdés I, Gajardo A, Charron-Prochownik D, Codner E. Risky sexual behaviors in adolescents and young adult women with type 1 diabetes: An overlooked problem. Pediatr Diabetes 2021; 22:1092-1098. [PMID: 34192395 DOI: 10.1111/pedi.13245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/27/2021] [Indexed: 11/28/2022] Open
Abstract
The presence of unprotected sex activity in women living with type 1 diabetes (T1D) who have insufficient glycemic control should be considered as a specific risky behavior. To evaluate risky behaviors, including unprotected sexual activity, sources of information and knowledge related to reproductive health in adolescents and young adult women with T1D (PwT1D) compared to a group of adolescents and young adult women without diabetes (Comparison group). PwT1D and the Comparison group completed a questionnaire with validated measures that assessed reproductive health. PwT1D (n = 115, age = 17.7 ± 3.2 years) and Comparison group (n = 386, age = 18.3 ± 2.9) were recruited. The proportion of women reporting having sex without any contraceptive was similar in both groups (57.1% and 50%, in PwT1D and Comparison group, respectively). The use of non-effective contraceptive was reported in 63.2% and 63.6% of the PwT1D and Comparison group, respectively. Among PwT1D, parents, formal sex education, and friends were the primary source of information on reproductive health. Low levels of knowledge about diabetes and pregnancy were observed in PwT1D. HbA1c level was associated with having at least one sexual activity without any contraception (OR = 1.63, p = 0.039). PwT1D have similar rates of risky behaviors compared to a Comparison group. Sexual risky behaviors should be especially considered in PwT1D with glycemic control above the optimal level. Parents are an important source of reproductive health information for PwT1D. Use of effective contraception should be reinforced in sexually active PwT1D.
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Affiliation(s)
- Franco Giraudo
- Institute Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile.,Juvenile Diabetes Foundation of Chile (FDJ), Santiago, Chile
| | - Ignacio Lalanne
- Institute Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile.,Juvenile Diabetes Foundation of Chile (FDJ), Santiago, Chile
| | - Ismael Valdés
- Institute Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile.,Juvenile Diabetes Foundation of Chile (FDJ), Santiago, Chile
| | - Abraham Gajardo
- Department of Medicine, University of Chile Clinical Hospital, Santiago, Chile.,Laboratory of Oxidative Stress, ICBM, University of Chile, Santiago, Chile
| | - Denise Charron-Prochownik
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ethel Codner
- Institute Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile
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Salinas A, Merino PM, Giraudo F, Codner E. Long-acting contraception in adolescents and young women with type 1 and type 2 diabetes. Pediatr Diabetes 2020; 21:1074-1082. [PMID: 32562346 DOI: 10.1111/pedi.13069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/28/2020] [Accepted: 06/15/2020] [Indexed: 12/16/2022] Open
Abstract
Adolescent pregnancy is a major public health problem worldwide. Adolescents living with diabetes are not aware of the risks of unplanned pregnancy and the high rate of fetal and maternal complications when gestation occurs in women with significant hyperglycemia. These data highlight the significance of pregnancy prevention in young women with diabetes. Long-acting reversible contraceptives (LARCs), which include subdermal progestin implants and hormonal and nonhormonal intrauterine devices (IUDs), have been recommended by the American College of Obstetricians Gynecologists and the American Academy of Pediatrics as a first-line contraceptive option for adolescents and young women. This article reviews LARC options for adolescents and young women with type 1 (T1D) and type 2 (T2D) diabetes as well as the possible complications and side effects.
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Affiliation(s)
- Abril Salinas
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.,Chilean Institute of Reproductive Medicine ICMER, Santiago, Chile
| | - Paulina M Merino
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Franco Giraudo
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.,Juvenile Diabetes Foundation of Chile FDJ, Santiago, Chile
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
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11
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Bolla AM, Dozio N, Scavini M, Succurro E, Tumminia A, Torlone E, Sasso FC, Vitacolonna E. Awareness about diabetes and pregnancy among diabetes specialists and fellows: The YoSID diabetes and pregnancy project. Nutr Metab Cardiovasc Dis 2020; 30:1520-1524. [PMID: 32665208 DOI: 10.1016/j.numecd.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS Despite evidence that pregnancy planning improves outcomes, in Italy, as in many other countries worldwide, <50% of women with diabetes prepare their pregnancy. The aim of this study was to document training and knowledge on diabetes and pregnancy (D&P) among diabetes professionals. METHODS AND RESULTS We administered an anonymous online questionnaire, focused on diabetes and pregnancy planning, to diabetes team members. Between Nov-2017 and Jul-2018, n = 395 professionals (60% diabetes/endocrinology/internal medicine specialists, 28% fellows) completed the survey. Fifty-nine percent of the specialists, mainly (78%) those completing their fellowship after 2006, reported having received training on D&P during fellowship. Considering specialists reporting training, 43% correctly identified fetal risks of inadequate preconceptional glucose control and 55% maternal risks, 38% identified risks associated with overweight/obesity, and 39% would prescribe hormonal contraception to women with diabetes only if glucose control is good. CONCLUSIONS The results of our survey suggest the need to improve training and awareness of professionals in the area of diabetes and pregnancy.
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Affiliation(s)
- Andrea M Bolla
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Marina Scavini
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Elena Succurro
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Andrea Tumminia
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi Hospital, Catania, Italy
| | - Elisabetta Torlone
- Endocrinology and Metabolic Diseases, University Hospital S. Maria della Misericordia, Perugia, Italy
| | - Ferdinando C Sasso
- University of Campania Luigi Vanvitelli, Department of Advanced Medical and Surgical Sciences, Naples, Italy
| | - Ester Vitacolonna
- Department of Medicine and Aging, G. d'Annunzio University, Chieti, Italy
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12
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Thong EP, Codner E, Laven JSE, Teede H. Diabetes: a metabolic and reproductive disorder in women. Lancet Diabetes Endocrinol 2020; 8:134-149. [PMID: 31635966 DOI: 10.1016/s2213-8587(19)30345-6] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/27/2019] [Accepted: 09/03/2019] [Indexed: 02/07/2023]
Abstract
Reproductive dysfunction is a common but little studied complication of diabetes. The spectrum of reproductive health problems in diabetes is broad, and encompasses delayed puberty and menarche, menstrual cycle abnormalities, subfertility, adverse pregnancy outcomes, and potentially early menopause. Depending on the age at diagnosis of diabetes, reproductive problems can manifest early on in puberty, emerge later when fertility is desired, or occur during the climacteric period. Historically, women with type 1 diabetes have frequently had amenorrhoea and infertility, due to central hypogonadism. With the intensification of insulin therapy and improved metabolic control, these problems have declined, but do persist. Additional reproductive implications of contemporary diabetes management are now emerging, including polycystic ovary syndrome and hyperandrogenism, which are underpinned by insulin action on the ovary. The sharp rise in type 2 diabetes incidence in youth suggests that more women of reproductive age will encounter diabetes-related reproductive problems in their lifetimes. With an ever increasing number of young women living with diabetes, clinicians need to be aware of and equipped for the challenges of navigating reproductive health concerns across the lifespan.
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Affiliation(s)
- Eleanor P Thong
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Department of Endocrinology and Diabetes, Monash Health, Clayton, VIC, Australia
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Department of Endocrinology and Diabetes, Monash Health, Clayton, VIC, Australia.
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