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Reproductive Health Counseling in the T1D Exchange Quality Improvement Collaborative.

Grenye O'Malley1, Selassie Ogyaadu1, Camilla Levister1

  • 1Icahn School of Medicine at Mount Sinai, New York, NY.

Diabetes Spectrum : a Publication of the American Diabetes Association
|November 19, 2025
PubMed
Summary
This summary is machine-generated.

Preconception planning for type 1 diabetes is crucial but often lacking. Most clinics discuss contraception and pregnancy, yet formal programs and patient contraception use remain low, impacting pregnancy outcomes.

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Area of Science:

  • Endocrinology
  • Reproductive Health
  • Diabetes Management

Background:

  • Preconception planning significantly reduces complications in pregnancies involving type 1 diabetes.
  • High periconception A1C levels are common, posing substantial risks to both mother and fetus.
  • Limited data exists on the specifics of preconception counseling effectiveness.

Purpose of the Study:

  • To assess current practices in preconception counseling and contraception use among type 1 diabetes centers.
  • To identify gaps in formal preconception counseling protocols and patient contraception adherence.
  • To inform quality improvement initiatives aimed at enhancing pregnancy outcomes for women with type 1 diabetes.

Main Methods:

  • The 2022 T1D Exchange Quality Improvement Collaborative (T1DX-QI) survey was administered to 50 centers (33 pediatric, 17 adult).
  • Survey data focused on center resources, practices regarding contraception, pregnancy planning, and patient A1C levels.
  • The study included females aged 13-50 with type 1 diabetes and recorded A1C values in the T1DX-QI database.

Main Results:

  • Most centers (74%) discuss contraception and (72%) pregnancy planning annually.
  • Formal preconception counseling protocols are rare (12% adult, 6% pediatric centers).
  • Low rates of contraception use (>80% of patients) were reported (12% adult, 9% pediatric), with only 15-24.4% of patients achieving goal A1C (<6.5%).

Conclusions:

  • Despite discussions on contraception and planning, formal preconception counseling and contraception use rates are low.
  • Attainment of target A1C levels before pregnancy remains a challenge.
  • Quality improvement efforts are essential to establish best practices for preconception care and improve pregnancy outcomes in type 1 diabetes.