Educating Diabetic Women on the Potential Teratogenic Effects of Hyperglycemia on Fetal Development during Pregnancy

Millions of people in the United States have diabetes, and that number has increased exponentially in the past three decades. This has led to an increased incidence of pregnancies complicated by pregestational diabetes mellitus (PGDM). PGDM has also increased the number of infants admitted to the neonatal intensive care unit (NICU) for congenital malformations and other perinatal complications associated with poor glycemic control. Many diabetic women are unaware of their risk for poor pregnancy outcomes related to gestational hyperglycemia and are unaware of measures they can take to reduce these risks. This project looked at the current preconception education provided by primary care providers (PCPs) to women with diabetes. A review of the literature revealed that nearly two million women of childbearing age have diabetes. Hyperglycemia is a hallmark of diabetes and is a known fetal teratogen. Neonates of women who are diabetic are at increased risk of admission to the NICU. Diabetes is associated with a higher risk of anomalies in multiple fetal organ systems. Preconception counseling for diabetic women of reproductive age in primary care is a missed opportunity for prevention of poor pregnancy outcomes. An educational tool designed for women with diabetes specific to hyperglycemia and fetal outcomes helps PCPs provide education in a quick and easy format to all women with type 1 or type 2 diabetes. A Research Data Capture program survey sent to PCPs in two community clinics elicited current diabetic patient counseling practices related to pregnancy. Based on this feedback, an educational tool in the form of a handout was developed to inform diabetic women of fetal complications associated with poor glycemic control. Following chair and content expert approval of the tool, select providers received a copy for their input. Based on the feedback of these providers, the educational tool underwent minor revisions. Women of childbearing age with diabetes were recruited to evaluate the content and format of the educational tool. Each participant showed an improvement between the pre- and post-questionnaire. The comments were positive as to the ease of understanding and information given. As demonstrated by evaluation of participant responses, the educational tool improved knowledge and thereby has the potential to improve outcomes for women, their infants, and their communities. Discussion with a representative from EpicTM, a proprietary electronic health record (EHR), occurred regarding integration of the tool into the EHR patient education database. The tool was presented at the Utah Conference for Public Health in March 2017. Unplanned pregnancies are common, and women of reproductive age who have diabetes may not be aware of the increased risk to themselves and their infants when their diabetes is not well controlled. Every opportunity should be taken to educate women about these risks and their roles in reducing these risks, and primary care is currently a missed opportunity. The proposed educational tool addresses this need by providing PCPs with an accessible patient resource as an adjunct to their current health care counseling.