Frequency of preconception education for teenage patients with diabetes attending an academic Pediatric Endocrinology Clinic
Purpose: Diabetes mellitus (DM) in pregnancy produces adverse outcomes with significant human and economic costs. Potential lifetime cost savings of preventative preconception counseling for women with diabetes may reach $4.3 billion (U.S.). Preconception education has been shown in prior research to improve knowledge of reproductive risks in an adolescent diabetic population and to improve future health outcomes. This study assessed the current extent of preconception DM-related reproductive risk education at a tertiary academic medical center to better inform the opportunity for a systematic quality improvement intervention.
Methods: We reviewed the electronic medical records (EMR) of females (N=70), ages 16-19, seen in the Pediatric Endocrinology clinic (2013-2016) and diagnosed with type 1 DM, type 2 DM, or insulin resistance. Any reproductive risks education documentation by providers, nursing or educators within Pediatric Endocrinology, or within consults to Nutrition or Obstetrics and Gynecology was reviewed and characterized.
Results: According to EMR documentation, patient education for nonreproductive medical needs and complications of DM were consistently present in this population: 96% of patients received general diabetes education with at least 4/8 components. However, documented education regarding DM reproductive risks occurred for only 18% of the same patients while contraceptive use discussion occurred for 20%.
Conclusion: The potential benefits of preconception education may include achieving recommended glucose control preceding and during pregnancy with fewer downstream maternal and fetal adverse outcomes. Although limited by the single site, retrospective design and the unknown rate of reproductive education documentation failure, our findings reveal a performance gap of potential downstream medical significance. Recognizing this deficiency provides an opportunity for a population-based intervention to create improved health outcomes.