PRECONCEPTION COUNSELING IN WOMEN WITH DIABETES BY PRIMARY CARE PROVIDERS AND PERCEIVED BARRIERS TO INITIATING THIS DISCUSSION.

Objective: To evaluate the frequency that women with diabetes mellitus seen by a primary care provider receive preconception counseling; to identify barriers to preconception counseling; and to determine differences between family medicine, internal medicine, and obstetrics and gynecology. Methods: This was a retrospective cohort study in which medical records were reviewed to determine if preconception counseling was done. An electronic survey evaluated how often preconception counseling was provided and identified perceived barriers to preconception counseling. Characteristics of those who received preconception counseling and those who did not, and survey responses between disciplines, were compared. Results: Women that met inclusion criteria: 577 (18.9% of whom received preconception counseling). A total of 88.7% of primary care providers indicated that preconception counseling was important, but only 39.2% reported that they regularly provide preconception counseling. Conclusion: Women with diabetes mellitus do not regularly receive preconception counseling by primary care providers. Lack of time and knowledge were the most commonly identified barriers to providing preconception counseling. Abbreviations: DM = diabetes mellitus; FM = family medicine; HbA1c = hemoglobin A1c; IM = internal medicine; LVHN = Lehigh Valley Health Network; Ob/Gyn = obstetrics/gynecology; PC = preconception counseling; PCP = primary care provider.

ADULT-ONSET HYPOPHOSPHATASIA: BEFORE AND AFTER TREATMENT WITH ASFOTASE ALFA.

OBJECTIVE: To review the diagnosis and clinical course of a woman with hypophosphatasia who is being treated with newly approved enzyme replacement therapy, asfotase alfa. METHODS: Clinical and laboratory data are presented. RESULTS: This is a unique report of a woman with debilitating adult-onset hypophosphatasia who was successfully diagnosed with low alkaline phosphatase (ALP) levels and elevated vitamin B6 levels. Treatment with asfotase alfa resolved her chronic bony pain symptoms and quadrupled her daily pedometer step count. Furthermore, whole body scans before and after treatment showed less focal uptake overall, suggesting fracture healing after enzyme replacement therapy. CONCLUSION: Improvement in patient reported symptoms, daily pedometer count, and whole body scans was noted after treatment of adult-onset hypophosphatasia with asfotase alfa enzyme replacement therapy. The significance of increased ALP levels after treatment is currently unknown.