What do women with diabetes know about pregnancy and contraception?

Maternal diabetes complicates one in 250 pregnancies in the UK. The risk of congenital malformation, stillbirth and neonatal death remains three to four times higher in women with diabetes than the background population. In 2005, a Confidential Enquiry into Maternal and Child Health report proposed that an improvement in pregnancy outcomes may be influenced by preconception care and careful planning of pregnancies. The National Service Framework for Diabetes recommended that women with diabetes be given advice about planning pregnancy and contraception annually. The aim of this audit was (1) to establish if women attending a routine diabetes clinic could recall information given to them relating to pregnancy and contraception, and (2) to ascertain if women who previously completed a pregnancy were able to recall more accurate information. A total of 100 women of child bearing age (up to age 40 years, 88% insulin treated) attending a diabetes clinic completed a questionnaire. Only 35% recalled having a discussion about contraception or pregnancy. Less than a quarter knew of risks to the baby and that good glycaemic control influenced these risks. Only 25% knew about folic acid supplements. The 31 patients who had had a previous pregnancy with diabetes had similar poor knowledge. In conclusion, two-thirds of women of child bearing age were unable to recall having had a discussion regarding pregnancy or contraception. There was poor understanding of the risks associated with pregnancy. A previous pregnancy and antenatal care did not improve knowledge. New educational strategies for preconceptual care are needed for women with diabetes, regardless of parity.