A (3:10)

And now our interview with Angela Magdaleno, an internal medicine resident at the Lehigh Valley Health Network. Dr. Magdaleno presented findings about preconception counseling at the Endocrine Society's annual meeting in Chicago, and we spoke with her there.

C (3:26)

Why is preconception counseling so important for women with diabetes?

D (3:30)

That's a great question. So, preconception counseling we loosely define as the discussion between a physician and the patient regarding the importance of tight glycemic control prior to conceiving in any woman of childbearing age who has diabetes. The importance of this discussion is that there's been many studies that have shown that diabetes complicates pregnancies in the maternal, the fetal and the obstetrical aspects of the pregnancy. There's been a direct correlation between hemoglobin A1c or the control of the diabetes with how well the pregnancy goes, the complications, the congenital malformations in the baby. And there's been studies that have proven that providing this preconception counseling and improving glycemic control in these women improves the outcome overall, reduces morbidity, mortality, reduces the healthcare costs in these pregnancies. And there's been many studies that really show the benefits of discussing this with the patients prior to them conceiving.

B (4:28)

So it seems like there are some very clear beneficial reasons to receive this preconception counseling, and it ought to be happening regularly.

D (4:35)

But is it then? That is what we researched. So in our study, we looked at women ages 18 to 35 with either type 1 or type 2 diagnostics who had an office visit with either a family medicine, internal medicine, or OB physician within the Lehigh Valley Health Network. And we reviewed over 500 charts of the patients that fit our criteria and read through the charts to see if it was documented that they received preconception counseling. And we saw an alarming rate of only 18% of those patients received preconception counseling in a three year period. And that's from all those primary care providers, especially those types.

C (5:16)

How aware are primary care providers that this is something that they should consider doing?

D (5:21)

They seem to think that they're educated on the topic and educated on the discussion. We did send out a very unique survey to providers, which actually has never been done before through the literature that I looked at. So we sent out a survey to over 500 providers. We had about 100 respond to us. And we asked them what they thought the barriers were and if they thought they were providing it, if they felt educated on it. We asked them quite a few questions. 39% of them felt that they were providing this preconception counseling and a lot of them felt that they were educated on it. However, it's alarming that 39% think they're providing it, but only 18% are providing it in a three year period.

B (5:58)

Did you go back to the physicians and were they surprised by your findings that there was actually a much lower percentage of them providing this counseling?

D (6:09)

That's a great question. We have not gone back to these physicians. We have some future plans with this unique survey. We found lot of barriers and we think we have some great future projects of implementing different QI ideas, quality improvement projects within our health network system, implementing these ideas and then going back and maybe resurveying these physicians, as well as reviewing further charts in the future to see if we can increase the rate of preconception counseling and reduce these barriers and make physicians more happier.

B (6:38)

Can you tell us a little bit more about what these barriers are?

D (6:41)

Yes. So on the survey, we gave them lots. There was like a 16 question survey and the, the majority of the respondents believed that the highest barriers were not enough time to discuss the preconception counseling. They felt they needed another appointment to discuss the preconception counseling. And the most alarming one we kind of thought was that they think women should be initiating this discussion. That's alarming to us because women may not know that this is something they need. They may not understand the risks of diabetes in pregnancy. They may not know they need tight glycemic control or it could lead to all these complications. So it was interesting that the physicians believed the women will bring it up. So that was an alarming one. The other ones with not enough time, that's, I think, a common problem in healthcare these days, that there's never enough time for things we need to do.

C (7:27)

Clearly you've identified a need that needs to be met. You've clearly identified some barriers that are there. And so it begs the question, what happens next? How do we help these folks get over these barriers and really get to what needs to be done?

D (7:42)

Great question. So we have a couple ideas of ways we want to go about this. So one idea we were thinking of is we have an electronic medical record system at Lehigh Valley Health Network. We use epic. We were thinking of implementing a notice notification that pops up for women who fit the criteria where they need preconception counseling. It could educate the provider on even how to go about bringing it up. It could cover there's certain topics that the provider should mention right then. And there in the appointment. And then the provider could hit accept, I did this. And then it could even have a part where it adds it in and then the provider provider is automatically documenting it. And that would kind of be an alarm system so the doctor doesn't forget as well as help them document an easy way for them to have it written there. Some other ideas we had was even you could put it in the after visit summary, some educational materials for the patient to receive that education if there wasn't enough time at that appointment, at least then they can go home and they could read about it and maybe come up with their own questions at their next appointment and bring it up themselves. We also thought even though physicians did feel they had enough education, we thought even maybe coming back and trying to educate them further about the importance of it would encourage them to do it more frequently. The American Diabetes association does recommend that all females of childbearing age with diabetes receive this counseling yearly, and that's not happening. So maybe if we educate our physicians on the importance of that and go back to the education board on why it's important and teach them, then they could pass it forward to There was one other important statistically significant association that we did find in our results. We found that the OB providers did have a higher proportion of women that they were providing the preconception counseling to. So the OB providers provided 36% of the preconception counseling. IM provided 10% and family medicine about 7%. So this was interesting to us that the OB were providing it more. We don't have a great explanation. We do have some ideas that maybe the OB providers interact with this patient population more. They frequently discuss contraception. They also more frequently see the outcomes and the complications associated with the diabetes during those pregnancies. So they more frequently see the complications and therefore probably are more likely to discuss it to prevent those complications.

C (9:59)

Seems like it's more front of mind. Maybe they're just more comfortable.

D (10:02)

Exactly, Exactly.

C (10:03)

Well, we want to thank you so much for your time with us and I hope a lot of our listeners have really taken this to heart and considered this as something as important that they should consider to do with their patients. Thank you so much.

D (10:13)

Thank you so much for having me. This was great.

B (10:15)

Thank you.

D (10:16)

Thank you.

B (10:17)

While preconception health is most commonly associated with women, preconception care is also important for men. Instead of a trivia question, I want to ask our audience what types of things men interested in becoming fathers can do for their own health and for the health of their future children. Email us@podcastrine.org we look forward to highlighting your answers in an upcoming episode.

A (10:42)

That's all for this episode. Thank you for listening to the Endocrine News Podcast. To learn more, visit www.endocrine.org podcast. There you can find this episode and some helpful links. We have some great episodes coming up, but we also want to know what matters to you. What would you like to hear about on the podcast? Send us your thoughts@podcastocrine.org you can subscribe to Endocrine News Podcasts on itunes or wherever you get your podcasts. Thanks again for listening. Endocrine News Podcasts are a free service of the Endocrine Society. To learn more or to become a member, visit the society's website at www.endocrine.org.