DIABETES AND PREGNANCY - FACTORS ASSOCIATED WITH SEEKING PRE-CONCEPTION CARE

OBJECTIVE- To define sociodemographic characteristics, medical factors , knowledge, attitudes, and health-related behaviors that distinguish women with established diabetes who seek pre-conception care from thos e who seek care only after conception. RESEARCH DESIGN AND METHODS- A multicenter, case-control study of women with established diabetes mak ing their first pre-conception visit (n = 57) or first prenatal visit without having received pre-conception care (n = 97). RESULTS- Pre-con ception subjects were significantly more likely to be married (93 vs. 51%), living with their partners (93 vs. 60%), and employed (78 vs. 41 %); to have higher levels of education (73% beyond high school vs. 41% ) and income (86% > $20,000 vs. 60%); and to have insulin-dependent di abetes mellitus (IDDM) (93 vs. 81%). Pre-conception subjects with IDDM were more likely to have discussed preconception care with their heal th care providers (98 vs. 51%) and to have been encouraged to get it ( 77 vs. 43%). In the prenatal group, only 24% of pregnancies were plann ed. Pre-conception patients were more knowledgeable about diabetes, pe rceived greater benefits of pre-conception care, and received more ins trumental support. CONCLUSIONS- Only about one-third of women with est ablished diabetes receive pre-conception care. Interventions must addr ess prevention of unintended pregnancy. Providers must regard every vi sit with a diabetic woman as a pre-conception visit. Contraception mus t be explicitly discussed, and pregnancies should be planned. In couns eling, the benefits of pre-conception care should be stressed and the support oi families and friends should be elicited.