Women with diabetes and hypertension don’t receive recommended pre-pregnancy counseling

For a paper published in The American Journal of Preventive Medicine 2021, lead author Cassondra Marshall, DrPH, MPH, and colleagues reviewed Center for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System (PRAMS) records of 105,658 survey respondents from  2016–2018 to determine whether or not women with type 1 or type 2 diabetes or hypertension received pre-pregnancy counseling.

Guidelines from the CDC, American Diabetes Association, and the American College of Obstetricians and Gynecologists recommend providers offer women with diabetes or hypertension pre-pregnancy health counseling to mitigate the increased maternal and infant risk associated with both conditions. However, not much is known about how many women actually receive this important counseling.

Pre-pregnancy counseling is counseling a woman receives from their health care provider in one or many visits—counseling can cover a variety of topics. For women with diseases like diabetes or hypertension, these counseling sessions can offer the information a woman needs to care for herself and any future children before pregnancy or even before conception.

Through PRAMS, the CDC asks women to provide responses a year after birth to see if  they received one or all of four types of pre-pregnancy counseling: counseling on folic acid, too much of which can cause neural defects in infants; a discussion on whether a woman desired to get pregnant; birth control counseling; and how to prepare for a healthy pregnancy. The study revealed that less than half the women reported receiving the recommended pre-pregnancy counseling. This shows a lack of care for women with these conditions and a need for “evidence-based and patient-centered models of pre-pregnancy counseling for those with diabetes and hypertension,” according to the study.

Previous studies have found that women—regardless of whether they have diabetes or hypertension—are less likely to know about their care and risk before or during pregnancy, regardless of age, race, whether they had been pregnant before. Black and Latina women of reproductive age are particularly impacted by diabetes and hypertension. The study’s data found that of the women surveyed, 18.51% non-Hispanic Black women had diabetes alone, 33.7% had hypertension alone, and 12.11% had both hypertension and diabetes. Of those Hispanic women surveyed, 29.23% of women had diabetes alone, 16.16% had hypertension alone, and 13.2% had both hypertension and diabetes.

The model used by physicians for pre-pregnancy counseling depends, according to Marshall, on how physicians are given options for patient-centered care.

Marshall hopes to expand her research to include the development of a decision-support tool that would allow patients to determine what they need from their physician before their visit. She is also looking to expand her study to include women who may have experienced stillbirths or deliveries other than live birth, a cross section of women missing from the dataset used in the paper.

“I’m an interventionist which means I’m always trying to get to a point where we can develop, implement and evaluate methods that can improve healthcare delivery. So given my interest, it’s helpful to see where things are now,” says Marshall.