Why Don't Women With Diabetes Plan Their Pregnancies?

  1. Frederick A Connell, MD, MPH
  1. Department of Obstetrics and Gynecology, University of Washington Seattle
  2. Department of Health Services, University of Washington Seattle
  3. Washington State Diabetes Control Program Olympia, Washington
  1. Address correspondence and reprint requests to Emily V. Holing, PhD, Department of Obstetrics and Gynecology, P.O. Box 356460, University of Washington, Seattle, WA 98195-6450. E-mail: eholing{at}u.washington.edu

Abstract

OBJECTIVE To determine why women with diabetes generally do not plan their pregnancies, consequently entering their pregnancies with poor blood glucose control and greatly increasing the risk of birth defects in their infants.

RESEARCH DESIGN AND METHODS A population-based sample of 85 women with diabetes diagnosed before the index pregnancy were recruited within 6 months postpartum from 15 hospitals in the state of Washington. Women with planned and unplanned pregnancies were compared using qualitative and quantitative analysis of personal interviews, self-administered questionnaires, and medical record review.

RESULTS Although most women (79%) knew they should optimize their blood glucose levels before conception, fewer than half (41%) of their pregnancies were planned. Women with planned pregnancies had significantly higher income and more education; were more likely to have private health insurance, to see an endocrinologist before pregnancy, to be happily married, and to be Caucasian; and were less likely to use tobacco. Most unplanned pregnancies were not contraceptive failures, but may have been consciously or subconsciously intended. Women with planned pregnancies generally described an ongoing and positive relationship with their health care providers. Women who felt that their doctors discouraged pregnancy were more likely to have an unplanned pregnancy than were women who had been reassured they could have a healthy baby.

CONCLUSIONS Many women with diabetes still perceive negative messages about pregnancies and become pregnant without optimal planning. We believe there are many opportunities for increasing the proportion of women with diabetes who plan their pregnancies, particularly in the areas of prepregnancy information, support that women are given, and the quality of the relationships they experience within the health care system. It is crucial that couples be reassured that with pre-conception glucose control, almost all women with diabetes can have healthy babies.

  • Received October 28, 1997.
  • Accepted February 6, 1998.
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