Preconception Counseling, Contraceptive Counseling, and Long-Acting Reversible Contraception Use in Women with Type I Diabetes: A Retrospective Cohort Study

Abstract

Background: Reproductive-age women with type I diabetes require preconception counseling, contraceptive counseling, and access to long-acting reversible contraception (LARC) to better support peri-conception glycemic control and decrease rates of unplanned pregnancies and adverse pregnancy outcomes. Materials and Methods: This retrospective cohort study identified women (16-49 years old) with an ICD-9/ICD-10 code for type I diabetes and documented hemoglobin A1c (HbA1c) level in a tertiary referral center between January 1, 2010 and October 30, 2017. We abstracted 2 years of data centered on the time of the highest recorded HbA1c. We identified preconception counseling, contraceptive counseling, LARC use, provider type, and the presence of advanced vascular complications or disease >20 years duration. Multivariable logistic regression related disease severity and provider type to counseling and LARC documentation when controlling for patient age and race. Results: Among 541 women, only 5% received preconception counseling, 25% received contraceptive counseling, and 13% used LARC. Younger age and more visits were associated with documented preconception or contraceptive counseling (p < 0.01). Maternal fetal medicine specialists most frequently documented preconception counseling (16%, p = 0.01), whereas gynecologists most frequently documented contraceptive counseling (73%, p < 0.01). Contraceptive counseling was highly associated with LARC use (adjusted odds ratio 9.87, 95% confidence interval 5.09-19.12). Conclusions: Reproductive-age women with type I diabetes have infrequent documentation of preconception counseling and contraceptive counseling. Educating primary care providers and endocrinologists could avoid missed opportunities to improve pregnancy planning and outcomes.