Preconception Counseling for Adolescents and Young Adults with Diabetes: a Literature Review of the Past 10 Years
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).
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.
KeywordsPreconception counseling Reproductive health Diabetes Adolescents Young adults Female
We would like to acknowledge Dr. Mary Lou Klem for her assistance with the literature search.
Compliance with Ethical Standards
Conflict of Interest
Frances Peterson-Burch, Hiba Abujaradeh, Nicole Charache, Andrea Fischl, and Denise Charron-Prochownik declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
- 3.•• 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.Google Scholar
- 6.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=S1679-45082015000400618&lng=en&tlng=en CrossRefGoogle Scholar
- 8.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.CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Jones P, Schmeltz R. Prevention of congenital malformation in infants of insulin-dependent diabetic mothers. Diabetes Spectr. 1995;8:288–9.Google Scholar
- 11.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.CrossRefPubMedPubMedCentralGoogle Scholar
- 13.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.Google Scholar
- 14.Bulletin AP. Pregestational diabetes mellitus. Clinical management guidelines for obstetrician-gynecologists. Number 60. Obstet Gynecol. 2005;60:675–85.Google Scholar
- 15.Charron-Prochownik D, Downs J. Diabetes and reproductive health for girls. Alexandria, VA; 2016.Google Scholar
- 16.•• 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.Google Scholar
- 17.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.Google Scholar
- 22.Newman BM, Newman PR. Development through life: a psychosocial approach. 13th ed. Cengage Learning: Boston; 2017.Google Scholar
- 27.•• 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.Google Scholar
- 28.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.CrossRefPubMedPubMedCentralGoogle Scholar
- 34.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.PubMedGoogle Scholar
- 36.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.Google Scholar
- 37.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.Google Scholar
- 38.Downs J, Charron-Prochownik D. READY-Girls (DVD). USA: University of Pittsburgh; 2008.Google Scholar
- 39.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.CrossRefGoogle Scholar
- 40.Charron-Prochownik D. Reproductive health awareness for teenage women with diabetes. Alexandria: American Diabetes Association; 2001. p. 1–41.Google Scholar
- 42.Feldman AZ, Brown FM. Management of type 1 diabetes in pregnancy. Curr Diab Rep. 2016;16(8).Google Scholar
- 47.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.Google Scholar
- 49.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.CrossRefPubMedGoogle Scholar
- 54.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.Google Scholar
- 60.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.Google Scholar
- 61.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.Google Scholar
- 62.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.Google Scholar
- 63.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.Google Scholar
- 64.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.Google Scholar
- 65.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.Google Scholar
- 66.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.Google Scholar
- 68.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;Google Scholar
- 69.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.Google Scholar