Mother-daughter dyadic approach for starting preconception counseling at puberty in girls with diabetes.

BACKGROUND: Preconception counseling (PC) significantly and inexpensively reduces risks of reproductive-health complications for women with diabetes. Our validated technology-based preconception counseling intervention, READY-Girls, is tailored for female teens with type 1 (T1D) and type 2 (T2D) diabetes and targets decision-making regarding effective family planning and seeking PC. Our teen-focused research was instrumental in changing the American Diabetes Association's Practice Recommendations to specify that preconception counseling should "Start at puberty…". This directive requires support from well-informed mothers of teens. Our goal is to provide both teen girls and their mothers with preconception counseling knowledge, and provide mothers with sex-communication training. Evaluation should focus on mother-daughter dyads. PURPOSE: This feasibility study explored mother's and daughter's awareness and knowledge of diabetes and pregnancy, and preconception counseling; and compared mother-daughter responses using dyadic analyses. METHODS: A mixed-method design was conducted with 10 mothers of daughters with T1D. Mothers were given READY-Girls intervention and completed knowledge and support questionnaires. Their responses were compared to those of their daughter's who were participating in a large randomized, control intervention trial with READY-Girls. RESULTS: The major theme from one-on-one interviews was, "I know nothing about diabetes/pregnancy risks and PC". Mother's and daughter's perceptions of having limited knowledge were confirmed by low knowledge scores. Mothers perceived giving higher levels of support compared to their daughter's perceptions of receiving support. CONCLUSION: Mothers can play a vital role in initiating discussions regarding reproductive-health with their daughters and reinforcing preconception counseling. Mother-daughter team approach for starting preconception counseling at puberty in girls with diabetes is feasible. Mother-daughter dyadic analyses can be important to explore possible mediating and moderating roles of mother-daughter communication and support about reproductive health on the relationship between READY-Girls intervention and sustainable outcomes.

A self-instructional program for diabetes educators on preconception counseling for women with diabetes.

PURPOSE: The purpose of this study was to develop, implement, and evaluate the effectiveness of a self-instructional preconception counseling (PC) training program for Certified Diabetes Educators (CDEs) to enhance PC knowledge and self-efficacy. METHODS: A 1-group, pre-post test study was conducted with 31 CDEs from a large medical center in western Pennsylvania. The self-instructional program included selected readings, such as the American Diabetes Association's position statement on PC of women with diabetes and an interactive CD-ROM, "Reproductive-Health Awareness for Teenage Women With Diabetes" ("READY-Girls"). Paper-and-pencil knowledge and self-efficacy questionnaires regarding PC and pregnancies of women with diabetes were completed by the CDEs before and immediately following the self-instructional program. Upon completion, participants received 5.0 Continuing Nursing Education contact hours (CNEs) from the State Nurses Association. RESULTS: Prior to receiving the program, all of the participants indicated they would benefit from further training on PC. Pretest knowledge scores averaged in the 70th percentile; following the program, the participants significantly increased (P < .01) PC knowledge and self-efficacy in providing PC to women with diabetes, including adolescents. CONCLUSIONS: Although CDEs knew relevant information, they lacked some specific knowledge about PC, and they lacked confidence in their knowledge and in their ability to counsel patients. Diabetes educators can benefit from an education program to provide PC to their female patients, including adolescents. Computer or Web-based accessibility could make this a low-cost and easily disseminated program.

Preconception planning: are we making progress?

According to the American Diabetes Association, unplanned pregnancies in women with diabetes could lead to abnormal metabolic control, which causes fetal and maternal complications. Preconception planning can decrease these risks. This article reports on the progress in preconception planning over the past 2 years.

Reproductive health and preconception counseling awareness in adolescents with diabetes: what they don't know can hurt them.

PURPOSE: This study explored the awareness of issues related to diabetes and pregnancy, preconception counseling (PC), and contraception in adolescent women with type 1 diabetes (T1D). METHODS: A descriptive-qualitative method was used to collect open-ended data during a telephone interview on reproductive health by same-gender research assistants. Eighty subjects were recruited from multiple sites (mean age = 17.6 +/- 1.0 year; range, 16-20). Questions focused on 2 themes, awareness of diabetes and reproductive health (pregnancy, PC, birth control) and where to seek information about these issues. Responses were written verbatim. Pattern recognition detected common themes. Results were cross-checked for interrater reliability. RESULTS: Overall, the response "don't know" or "never heard about it" was most frequently given. Most teens in this sample were unaware of the term preconception counseling; 65% (n = 52) indicated they knew nothing about PC. Many were not aware of the risks of pregnancy-related complications in women with diabetes. One fourth of the teens were aware of preplanning a pregnancy and the importance of good metabolic control. Many knew where to seek information about diabetes and pregnancy, and birth control. CONCLUSIONS: This sample of teens lacked awareness of pregnancy-related complications with diabetes, the term and role of PC in preventing these complications, and the importance for women with diabetes to use a highly effective birth control method for preventing an unplanned pregnancy. Because of its implications for future reproductive health behavior and preventing unplanned pregnancies and complications, during their routine clinic visits, it is imperative for health professionals to raise these issues with their adolescent female patients.