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02-15-2018 | Psychological support | Review | Article

Preconception Counseling for Adolescents and Young Adults with Diabetes: a Literature Review of the Past 10 Years

Journal: Current Diabetes Reports

Authors: Frances Peterson-Burch, Hiba Abujaradeh, Nicole Charache, Andrea Fischl, Denise Charron-Prochownik

Publisher: Springer US


Purpose of Review

Women with diabetes who have unplanned pregnancies and uncontrolled blood sugars are at a higher risk for maternal and fetal morbidities and mortalities. Preconception counseling (PC) has been shown to decrease the risks and improve health outcomes. From 2009 to 2017, the American Diabetes Association has recommended that preconception counseling be given at each clinic visit for all women with diabetes of childbearing age starting at puberty (prior to sexual debut).

Recent Findings

This article reports both national and international progress in PC efforts for adolescents and young adults (12–34 years) with diabetes over the past decade. Twenty-eight publications were identified and included in this article (11 were research, 12 clinical guidelines, and 5 reviews).


Despite recommendations to start PC at puberty, only four studies had interventions that targeted the adolescent and young adult age group. Three of them were associated with the same PC awareness program. Positive outcomes were reported in all of these studies. Greater family vigilance was observed in a long-term follow-up of a cohort of women who received PC as teens. Adolescents should receive awareness PC. More early PC interventions and cohort follow-up studies are needed among adolescents and young adults, using technology that appeals to this age group. Programs should be expanded to include other populations like males with diabetes and females from other cultures and religions that would require program modification.
Kitzmiller J, Cloherty J, Younger M, Tabatabaii A, Rothchild S, Sosenko J, et al. Diabetic pregnancy and perinatal mortality. J Obstet Gynecol. 1978;131(5):560–80. https://​doi.​org/​10.​1016/​0002-9378(78)90120-5.CrossRef
Kitzmiller JL, Gavin LA, Gin GD, Jovanovic-Peterson L, Main EK, Zigrang WD. Preconception care of diabetes: glycemic control prevents congenital anomalies. JAMA. 1991;265(6):731–6. https://​doi.​org/​10.​1001/​jama.​1991.​03460060063025.CrossRefPubMed
•• American Diabetes Association. Standards of medical care in diabetes—2017. Diabetes Care. 2017;40(January):1–142. These guidelines set the standard for routine diabetes care and recommend that awareness PC start at puberty in adolescents with diabetes.
American Diabetes Association. Standards of medical care in diabetes—2008. Diabetes Care. 2008;31(Suppl 1):S12–54. https://​doi.​org/​10.​2337/​dc08-S012.CrossRef
Lawrence JM, Contreras R, Chen W, Sacks DA. Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women. Diabetes Care. 2008;31(5):899–904. https://​doi.​org/​10.​2337/​dc07-2345.CrossRefPubMed
de Azevedo WF, Diniz MB, da Fonseca ESVB, de Azevedo LMR, Evangelista CB. Complications in adolescent pregnancy: systematic review of the literature. Einstein (São Paulo). 2015;13(4):618–26. https://​doi.​org/​10.​1590/​S1679-45082015RW3127. Available from: http://​www.​scielo.​br/​scielo.​php?​script=​sci_​arttext&​pid=​S1679-4508201500040061​8&​lng=​en&​tlng=​en CrossRef
Helgeson VS, Siminerio L, Escobar O, Becker D. Predictors of metabolic control among adolescents with diabetes: a 4-year longitudinal study. J Pediatr Psychol. 2009;34(3):254–70. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​18667479 CrossRefPubMed
Wiebe DJ, Chow CM, Palmer DL, Butner J, Butler JM, Osborn P, et al. Developmental processes associated with longitudinal declines in parental responsibility and adherence to type I diabetes management across adolescence. J Pediatr Psychol. 2014;39(5):532–41. https://​doi.​org/​10.​1093/​jpepsy/​jsu006.CrossRefPubMedPubMedCentral
Jones P, Schmeltz R. Prevention of congenital malformation in infants of insulin-dependent diabetic mothers. Diabetes Spectr. 1995;8:288–9.
Codner E, Soto N, Merino PM. Contraception and pregnancy in adolescents with type 1 diabetes: a review. Pediatr Diabetes. 2012;13(1):108–23. https://​doi.​org/​10.​1111/​j.​1399-5448.​2011.​00825.​x.CrossRefPubMed
Fischl AR, Herman WH, Sereika SM, Hannan M, Becker D, Mansfield MJ, et al. Impact of a preconception counseling program for teens with type 1 diabetes (READY-Girls) on patient-provider interaction, resource utilization, and cost. Diabetes Care. 2010;33(4):701–5. https://​doi.​org/​10.​2337/​dc09-1821.CrossRefPubMedPubMedCentral
Herman WH, Janz NK, Becker MP, Charron-Prochownik D. Preconception care, pregnancy outcomes, resource utilization and costs. J Reprod Med. 1999;44(1):33–8.PubMed
Cyganek K, Katra B, Hebda-Szydło A, Janas I, Trznadel-Morawska I, Witek P, et al. Changes in preconception treatment and glycemic control in women with type 1 diabetes mellitus—a 15 year long single centre observation. Polish Arch Intern Med. 2016;126(10):739–45.
Bulletin AP. Pregestational diabetes mellitus. Clinical management guidelines for obstetrician-gynecologists. Number 60. Obstet Gynecol. 2005;60:675–85.
Charron-Prochownik D, Downs J. Diabetes and reproductive health for girls. Alexandria, VA; 2016.
•• Tieu J, Middleton P, Ca C, Shepherd E. Preconception care for diabetic women for improving maternal and infant health (Review). Cochrane Data Syst Rev. 2017;8:1–39. This article reviewed all of the RCTs of PC for young women with diabetes. It provided a summary on the current state of research for PC interventions in young women with diabetes and provided recommendations for future research.
Tieu J, Middleton P, Ca C. Preconception care for diabetic women for improving maternal and infant health. Cochrane Data Syst Rev. 2010;12:1–16.
Temple R. Preconception care for women with diabetes: is it effective and who should provide it? Best Pract Res Clin Obstet Gynaecol. 2011;25(1):3–14. https://​doi.​org/​10.​1016/​j.​bpobgyn.​2010.​10.​001.CrossRefPubMed
Wahabi HA, Alzeidan RA, Esmaeil SA. Pre-pregnancy care for women with pre-gestational diabetes mellitus: a systematic review and meta-analysis. BMC Public Health. 2012;12(1):792. https://​doi.​org/​10.​1186/​1471-2458-12-792.CrossRefPubMedPubMedCentral
American Academy of Pediatrics Committee on Adolescence, Blythe MJ, Diaz A. Contraception and adolescents. Pediatrics. 2007;120(5):1135–48. https://​doi.​org/​10.​1542/​peds.​2007-2535. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​17974753 CrossRef
Charron-Prochownik D, Hannan MF, Fischl AR, Slocum JM. Preconception planning: are we making progress? Curr Diab Rep. 2008;8(4):294–8. https://​doi.​org/​10.​1007/​s11892-008-0052-8.CrossRefPubMed
Newman BM, Newman PR. Development through life: a psychosocial approach. 13th ed. Cengage Learning: Boston; 2017.
Zhu H, Graham D, Teh RW, Hornbuckle J. Utilisation of preconception care in women with pregestational diabetes in Western Australia. Aust New Zeal J Obstet Gynaecol. 2012;52(6):593–6. https://​doi.​org/​10.​1111/​ajo.​12010.CrossRef
Sapiano K, Savona-Ventura C, Calleja-Agius J, Serracino-Inglott A, Azzopardi LM. Attitudes towards preconception care in Maltese women with type 1 diabetes mellitus. Gynecol Endocrinol. 2012;28(12):1006–9. https://​doi.​org/​10.​3109/​09513590.​2012.​705370.CrossRefPubMed
Holmes VA, Spence M, Mccance DR, Patterson CC, Harper R, Alderdice FA. Evaluation of a DVD for women with diabetes: impact on knowledge and attitudes to preconception care. Diabet Med. 2012;29(7):950–6. https://​doi.​org/​10.​1111/​j.​1464-5491.​2012.​03650.​x.CrossRefPubMed
Charron-Prochownik D, Ferons-Hannan M, Sereika S, Becker D. Randomized efficacy trial of early preconception counseling for diabetic teens (READY-Girls). Diabetes Care. 2008;31(7):1327–30. https://​doi.​org/​10.​2337/​dc07-1266.CrossRefPubMedPubMedCentral
•• Sereika SM, Becker D, Schmitt P, Iii ABP, Diaz AM, Fischl AFR, et al. Operationalizing and examining family planning vigilance in adult women with type 1 diabetes. Diabetes Care. 2016;39(December):1–7. This is the only longitudinal follow-up study of a cohort of women who received a PC counseling program (READY-Girls) during adolescence, which showed significant positive reproductive health outcomes in women with diabetes.
Charron-Prochownik D, Sereika SM, Becker D, White NH, Schmitt P, Blair Powell A, et al. Long-term effects of the booster-enhanced READY-girls preconception counseling program on intentions and behaviors for family planning in teens with diabetes. Diabetes Care. 2013;36(12):3870–4. https://​doi.​org/​10.​2337/​dc13-0355.CrossRefPubMedPubMedCentral
Downs JS, Arslanian S, Bruine de Bruin W, Carr Copeland V, Doswell W, Herman W, et al. Implications of type 2 diabetes on adolescent reproductive health risk. Diabetes Educ. 2010;36(6):911–9. https://​doi.​org/​10.​1177/​0145721710383586​.CrossRefPubMedPubMedCentral
Griffiths F, Lowe P, Boardman F, Ayre C, Gadsby R. Becoming pregnant: exploring the perspectives of women living with diabetes. Br J Gen Pract. 2008;58(548):184–90. https://​doi.​org/​10.​3399/​bjgp08X277294.CrossRefPubMedPubMedCentral
Mccorry NK, Hughes C, Spence D, Holmes VA, Harper R. Pregnancy planning and diabetes: a qualitative exploration of women’s attitudes toward preconception care. J Midwifery Women’s Health. 2012;57(4):396–402. https://​doi.​org/​10.​1111/​j.​1542-2011.​2011.​00143.​x.CrossRef
Mortagy I, Kielmann K, Baldeweg SE, Modder J, Pierce MB. Integrating preconception care for women with diabetes into primary care: a qualitative study. Br J Gen Pract. 2010;60(580):815–21. https://​doi.​org/​10.​3399/​bjgp10X532594.CrossRefPubMedPubMedCentral
Burns AC. The expanded health belief model as a basis for enlightened preventive health care practice and research. J Health Care Mark. 1992;12(3):32–45.PubMed
Charron-Prochownik D, Sereika SM, Becker D, Jacober S, Mansfield J, White NH, et al. Reproductive health beliefs and behaviors in teens with diabetes: application of the expanded health belief model. Pediatr Diabetes. 2001;2(1):30–9. https://​doi.​org/​10.​1046/​j.​1399-543x.​2001.​00000.​x.PubMed
Charron-Prochownik D, Wang S, Sereika SM, Kim Y, Janz NK. A theory-based reproductive health and diabetes instrument. Am J Health Behav. 2006;30(2):208–20. https://​doi.​org/​10.​5993/​AJHB.​30.​2.​10.CrossRefPubMed
Charron-Prochownik D. Reproductive-health awareness for teenage women with diabetes: what teens want to know about sexuality, pregnancy, and diabetes. Alexandria: American Diabetes Association; 2003.
Charron-Prochownik D, Downs J. READY-Girls—Reproductive-health Education & Awareness of Diabetes in Youth for Girls. Pittsburgh: University of Pittsburgh; 2009. p. 1–39.
Downs J, Charron-Prochownik D. READY-Girls (DVD). USA: University of Pittsburgh; 2008.
Charron-Prochownik D, Hannan MF, Sereika SM, Becker D, Rodgers-Fischl A. How to develop CD-ROMs for diabetes education: exemplar “Reproductive-health Education and Awareness of Diabetes in Youth for Girls” (READY-Girls). Diabetes Spectr. 2006;19(2):110–5. https://​doi.​org/​10.​2337/​diaspect.​19.​2.​110.CrossRef
Charron-Prochownik D. Reproductive health awareness for teenage women with diabetes. Alexandria: American Diabetes Association; 2001. p. 1–41.
Shawe J, Smith P, Stephenson J. Use of contraception by women with type 1 or type 2 diabetes mellitus: “it”s funny that nobody really spoke to me about it. Eur J Contracept Reprod Health Care. 2011;16(5):350–8. https://​doi.​org/​10.​3109/​13625187.​2011.​597896.CrossRefPubMed
Feldman AZ, Brown FM. Management of type 1 diabetes in pregnancy. Curr Diab Rep. 2016;16(8).
Abell SK, Nankervis A, Khan KS, Teede HJ. Type 1 and type 2 diabetes preconception and in pregnancy: health impacts, influence of obesity and lifestyle, and principles of management. Semin Reprod Med. 2016;34(2):110–20. https://​doi.​org/​10.​1055/​s-0035-1571196.CrossRefPubMed
Egan AM, Murphy HR, Dunne FP. The management of type 1 and type 2 diabetes in pregnancy. QJM An Int J Med. 2015;108(12):923–7. https://​doi.​org/​10.​1093/​qjmed/​hcv060.CrossRef
McCance DR. Diabetes in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2015;29(5):685–99. https://​doi.​org/​10.​1016/​j.​bpobgyn.​2015.​04.​009.CrossRefPubMed
Mukherjee MS, Coppenrath VA, Dallinga BA. Pharmacologic management of types 1 and 2 diabetes mellitus and their complications in women of childbearing age. Pharmacotherapy. 2015;35(2):158–74. https://​doi.​org/​10.​1002/​phar.​1535.CrossRefPubMed
Cyganek K, Klupa T, Szopa M, Katra B, Małecki MT. Medical care of pregnant women with type 1 diabetes: current guidelines and clinical practice. Pol Arch Med Wewnętrznej. 2013;123(1–2):59–65.
Group B. Preconception care for women with diabetes. Drug Ther Bull. 2008;46(5):36–40.CrossRef
Bismuth E, Bouche C, Caliman C, Lepercq J, Lubin V, Rouge D, et al. Management of pregnancy in women with type 1 diabetes mellitus: guidelines of the French-Speaking Diabetes Society (Société francophone du diabète [SFD]). Diabetes Metab. 2012;38(3):205–16. https://​doi.​org/​10.​1016/​j.​diabet.​2012.​02.​010.CrossRefPubMed
Choby B. Diabetes update: primary care of patients with type 1 diabetes. FP Essent. 2017;456:11–9.PubMed
Unger J. Management of diabetes in pregnancy, childhood, and adolescence. Prim Care Clin Off Pract. 2007;34(4):809–43. https://​doi.​org/​10.​1016/​j.​pop.​2007.​07.​008.CrossRef
Fleming SE, Corbett C. Promoting stringent glycemic control before and during pregnancy: evidence- and theory-based strategies. Nurs Womens Health. 2010;14(4):280–8. https://​doi.​org/​10.​1111/​j.​1751-486X.​2010.​01558.​x.CrossRefPubMed
Mahmud M, Mazza D. Preconception care of women with diabetes: a review of current guideline recommendations. BMC Womens Health. 2010;10(1):5. https://​doi.​org/​10.​1186/​1472-6874-10-5.CrossRefPubMedPubMedCentral
Abujaradeh H, Olshansky E, Peterson-Burch F, Montgomery K, Sorkin D, Zender R, et al. Examining perceptions of communication regarding diabetes, sex, family planning, pregnancy, and preconception counseling among diabetic young Latinas, their mothers and healthcare providers. In: Nursing Research. Lippincott Williams & Wilkins Two Commerce sq, 2001 Market St., Philadelphia, PA 19103 USA; 2017. p E112–3.
Kalra B, Gupta Y, Kalra S. Pre-conception management of diabetes. J Pak Med Assoc. 2015;65(11):1242–3.PubMed
Hitman GA. Pre-conception and diabetes: are we doing enough? Diabet Med. 2014;31(9):1021. https://​doi.​org/​10.​1111/​dme.​12549.CrossRefPubMed
Modder J. Diabetes in pregnancy: can we make a difference? BJOG An Int J Obstet Gynaecol. 2008;115(4):419–20. https://​doi.​org/​10.​1111/​j.​1471-0528.​2007.​01643.​x.CrossRef
Murphy HR. Prepregnancy care: improvements for some women but not for all! Pol Arch Med Wewn. 2016;126(10):729–30. https://​doi.​org/​10.​20452/​pamw.​3596.PubMed
Michel B, Charron-Prochownik D. Diabetes nurse educators and preconception counseling. Diabetes Educ. 2006;32(1):108–16. https://​doi.​org/​10.​1177/​0145721705284371​.CrossRefPubMed
Charron-Prochownik D, Abujaradeh H, Peterson-Burch F, Montgomery K, Sorkin D, Zender D, et al. Perceptions among diabetic adolescent Latinas and their mothers regarding diabetes, family planning and pregnancy: converging themes to inform preconception counseling. San Diego: American Diabetes Association; 2017.
Peterson-Burch F, Charron-Prochownik D, Montgomery K, Sorkin D, Zender R, Abujaradeh H, et al. Reproductive health awareness and communication in diabetic adolescent Latinas and their mothers. San Diego: Society of Behavioral Medicine; 2017.
Charache N, Peterson-Burch F, Olshansky E, Montgomery K, Abujaradeh H, Sorkin D, et al. Perceptions and influence of the extended family in sex, family planning and pregnancy among adolescent Latinas with diabetes. Memphis: National Council on Undergraduate Research Conference; 2017.
Olshansky E, Peterson-Burch F, Choi J, Schmitt P, Zender R, Charron-Prochownik D. Barriers and facilitators for health care providers to discuss reproductive health with Latinas diabetes mellitus. Diabetes J Am Diabetes. 2016;65(1):658.
Peterson-Burch F, Charron-Prochownik D, Schmitt P, Zender R, Choi J, Olshansky E. Exploring cultural experiences and knowledge of a health professional expert panel on reproductive health among adolescent Latinas with diabetes. Nurs Res. 2016;65(2):E106.
Moore K, Stotz S, Marshall G, Terry M, Schmitt P, Peterson-Burch F, et al. Tribal health leaders’ recommendations for a community-based gestational diabetes prevention counseling and education program for American Indian and Alaska native girls. Denver: American Public Health Association; 2016.
Choi J, White N, Sereika S, Schmitt P, Charron-Prochownik D. Examining family planning vigilant behavior in adolescent females with type 2 diabetes. Diabetes J Am Diabetes. 2014;63(Supp. 1A):147–B.
Murphy HR, Temple RC, Ball VE, Roland JM, Steel S, Zill-E-Huma R, et al. Personal experiences of women with diabetes who do not attend pre-pregnancy care. Diabet Med. 2010;27(1):92–100. https://​doi.​org/​10.​1111/​j.​1464-5491.​2009.​02890.​x.CrossRefPubMed
Fischl A, Rofey D, Charron-Prochownik D, Swarmer D, Diaz A, Libman I. Perceptions of reproductive health and complications among adolescent and young adult males with T1D. 77th Am Diabetes Assoc Sci Sess San Diego, CA. 2017;
Moore K, Stotz S, Nadeau K, Terry MA, Reyes YG, Gonzales K, et al. Perspectives and recommendations from American Indian and Alaska native adolescent girls for a community based gestational diabetes prevention and reproduction health counseling and education program. Am Acad Pediatr Pediatr Soc Int Meet Indig Child Heal Conf Denver, CO. 2017.

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