J Klein1, J A Boyle2, R Kirkham3, C Connors4, C Whitbread5, J Oats6, F Barzi3, D McIntyre7, I Lee3, M Luey8, J Shaw9, A D H Brown10, L J Maple-Brown11. 1. Royal Darwin Hospital, Darwin, Australia; Department of Obstetrics and Gynaecology, Eastern Health, Melbourne, Australia. 2. Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Menzies School of Health Research, Darwin, Australia. 3. Menzies School of Health Research, Darwin, Australia. 4. Northern Territory Department of Health, Darwin, Australia. 5. Royal Darwin Hospital, Darwin, Australia; Menzies School of Health Research, Darwin, Australia. 6. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. 7. Mater Medical Research Institute, University of Queensland, Brisbane, Australia. 8. Central Australian Aboriginal Congress, Alice Springs, Australia. 9. Baker IDI Heart and Diabetes Institute, Melbourne, Australia. 10. South Australian Health and Medical Research Institute, Adelaide, Australia; University of South Australia, Adelaide, Australia. 11. Royal Darwin Hospital, Darwin, Australia; Menzies School of Health Research, Darwin, Australia. Electronic address: louise.maple-brown@menzies.edu.au.
Abstract
AIMS: Preconception care may decrease adverse pregnancy outcomes associated with pre-existing diabetes mellitus. Aboriginal Australians are at high risk of type 2 diabetes mellitus (T2DM), with earlier onset. We explored practitioner views on preconception care delivery for women with T2DM in the Northern Territory, where 31% of births are to Aboriginal women. METHODS: Mixed-methods study including cross-sectional survey of 156 health practitioners and 11 semi-structured interviews. RESULTS: Practitioners reported low attendance for preconception care however, 51% provided counselling on an opportunistic basis. Rural/remote practitioners were most likely to find counselling feasible. The majority (69%) utilised appropriate guidelines and addressed lifestyle modifications including smoking (81%), weight management (79%), and change medications appropriately such as ceasing ACE inhibitors (69%). Fewer (40%) prescribed the recommended dose of folate (5mg) or felt comfortable recommending delaying pregnancy to achieve optimal preconception glucose control (42%). Themes identified as barriers to care included the complexity of care setting and infrequent preconception consultations. There was a focus on motivation of women to make informed choices about conception, including birth spacing, timing and contraception. Preconception care enablers included cross-cultural communication, a multi-disciplinary care team and strong client-based relationships. CONCLUSIONS: Health practitioners are keen to provide preconception counselling and reported knowledge of evidence-based guidelines. Improvements are needed in recommending high dose folate and optimising glucose control. Cross-cultural communication and team-based care were reported as fundamental to successful preconception care in women with T2DM. Continued education and policy changes are required to support practitioners in opportunities to enhance pregnancy planning.
AIMS: Preconception care may decrease adverse pregnancy outcomes associated with pre-existing diabetes mellitus. Aboriginal Australians are at high risk of type 2 diabetes mellitus (T2DM), with earlier onset. We explored practitioner views on preconception care delivery for women with T2DM in the Northern Territory, where 31% of births are to Aboriginal women. METHODS: Mixed-methods study including cross-sectional survey of 156 health practitioners and 11 semi-structured interviews. RESULTS: Practitioners reported low attendance for preconception care however, 51% provided counselling on an opportunistic basis. Rural/remote practitioners were most likely to find counselling feasible. The majority (69%) utilised appropriate guidelines and addressed lifestyle modifications including smoking (81%), weight management (79%), and change medications appropriately such as ceasing ACE inhibitors (69%). Fewer (40%) prescribed the recommended dose of folate (5mg) or felt comfortable recommending delaying pregnancy to achieve optimal preconception glucose control (42%). Themes identified as barriers to care included the complexity of care setting and infrequent preconception consultations. There was a focus on motivation of women to make informed choices about conception, including birth spacing, timing and contraception. Preconception care enablers included cross-cultural communication, a multi-disciplinary care team and strong client-based relationships. CONCLUSIONS: Health practitioners are keen to provide preconception counselling and reported knowledge of evidence-based guidelines. Improvements are needed in recommending high dose folate and optimising glucose control. Cross-cultural communication and team-based care were reported as fundamental to successful preconception care in women with T2DM. Continued education and policy changes are required to support practitioners in opportunities to enhance pregnancy planning.
Authors: Jennifer M Yamamoto; Deborah J F Hughes; Mark L Evans; Vithian Karunakaran; John D A Clark; Nicholas J Morrish; Gerry A Rayman; Peter H Winocour; Clare Hambling; Amanda W Harries; Michael J Sampson; Helen R Murphy Journal: Diabetologia Date: 2018-05-09 Impact factor: 10.122
Authors: R Kirkham; N Trap-Jensen; J A Boyle; F Barzi; E L M Barr; C Whitbread; P Van Dokkum; M Kirkwood; C Connors; E Moore; P Zimmet; S Corpus; A J Hanley; K O'Dea; J Oats; H D McIntyre; A Brown; J E Shaw; L Maple-Brown Journal: BMC Pregnancy Childbirth Date: 2019-10-28 Impact factor: 3.007
Authors: Anna Wood; Diana MacKay; Dana Fitzsimmons; Ruth Derkenne; Renae Kirkham; Jacqueline A Boyle; Christine Connors; Cherie Whitbread; Alison Welsh; Alex Brown; Jonathan E Shaw; Louise Maple-Brown Journal: Int J Environ Res Public Health Date: 2020-01-22 Impact factor: 3.390