Suboptimal Pre-Pregnancy Care in Women With T2D

TOPLINE:

This UK study highlighted suboptimal pre-pregnancy care in women of reproductive age with type 2 diabetes (T2D), emphasising the lack of contraception and risks associated with medication use.

METHODOLOGY:

• Researchers assessed pregnancy-related risk factors and medication exposures in women with T2D in UK primary care, evaluating adherence to specific National Institute for Health and Care Excellence (NICE) pre-pregnancy guidelines.
• They collected sociodemographic and medical data, including A1c levels, body mass index, and medication profiles, from 725 women with T2D aged 18-45 years.
• A1c levels were categorised as > 48 mmol/mol, 48-57 mmol/mol, 58-69 mmol/mol, 70-85 mmol/mol, or ≥ 86 mmol/mol to assess glycaemic control and adherence to guidelines.
• Specific data on contraception prescriptions and usage patterns among different demographic groups were gathered from 29 general practices in South London.
• Cross-sectional data from September to October 2022 were analysed to examine associations between clinical factors and prescription of medications not recommended for pregnancy.

TAKEAWAY:

• Only 11% of women were prescribed contraception by their general practitioner in the past 12 months. Asian (odd ratio [OR], 0.392; P = .022) and Black (OR, 0.367; P = .001) women had lower odds of receiving contraception than White women.
• Overall, 37.1% of women received prescriptions for medications not recommended during pregnancy.
• None of the women fulfilled all five specified NICE pre-pregnancy criteria, and 4.2% met none of the criteria. Only 29% had an HbA1c level < 48 mmol/mol, and 5% were prescribed high-dose folic acid.
• The use of multiple medications (OR, 3.49; P < .001) and older age (OR, 1.044; P = .034) were significant risk factors for being prescribed medications not recommended for pregnancy.

IN PRACTICE:

“Our findings emphasise the need for the consistent assessment of the reproductive intentions of women with type 2 diabetes in primary care settings, followed by the provision of either acceptable contraception or appropriate pre-pregnancy advice and intervention incorporating a comprehensive medication review,” the authors wrote.

SOURCE:

The study was led by Alexandra M. Famiglietti, King’s College London, London, United Kingdom. It was published online on March 5, 2025, in BMJ Open Diabetes Research & Care.

LIMITATIONS:

A study limitation was that electronic medical records likely underestimated contraceptive use, as non-prescription methods were not accounted for. Additionally, data completeness was a concern due to reliance on accurate diabetes coding and the exclusion of missing data to maintain analysis quality. The study could not verify actual medication use, which was crucial given known adherence challenges in this population.

DISCLOSURES:

This study was funded by the National Institute for Health and Care Research under its Health and Social Care Delivery Research Programme. Anna Hodgkinson participated in projects funded by Abbott and Boehringer Ingelheim and conducted education sessions for Novo Nordisk. The other authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.