Reproductive Health Counseling in the T1D Exchange Quality Improvement Collaborative

Preconception planning can reduce complications in pregnancy with type 1 diabetes. However, high periconception A1C is not uncommon and increases maternal and fetal risks. Because of limited data regarding preconception counseling, questions about education and contraception use were added to the 2022 T1D Exchange Quality Improvement Collaborative (T1DX-QI) survey.

The annual T1DX-QI survey was conducted in August and September 2022 with a center response rate of 94% of 50 centers, including 33 pediatric centers (66%) and 17 adult centers (34%). Representatives from each center answered questions relating to center resources and practices. The study includes females of reproductive age (13-50 years) diagnosed with type 1 diabetes who had at least one A1C value in 2022 in the T1DX-QI database.

Most centers report discussing contraception (74%) and pregnancy planning (72%) at least once per year. Among pediatric centers, 42% report always asking about menstruation history, compared with 6% of adult centers. Only 12% of adult centers and 6% of pediatric centers have a formal preconception counseling protocol. Only 12% of adult centers and 9% of pediatric centers estimated that >80% of their patients of childbearing potential were using contraception. Of females aged 13-50 years of age with type 1 diabetes, 15% at pediatric centers and 24.4% at adult centers had an A1C <6.5% at the time of the survey.

Although most centers reported discussing contraception and pregnancy planning, estimated rates of formal preconception counseling programs, contraception use, and attaining goal A1C remain low. Quality improvement efforts are needed to determine rates of preconception counseling and implement best practices to improve pregnancy outcomes.