Population Health Research and PICOT Statement

PICOT Statement

In women having type 2 diabetes, how efficient is counseling before conception, improving the clinical results. The PICO elements are:

•P (population) = Female who are at childbearing age having type 2 diabetes

•I (intervention) = Counseling before conception

•C (comparison) = Women who did and did not go through counseling before conception

•O (outcome) = Healthier babies, fewer problems during pregnancy and better metabolic control

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Population Health Research

Preexisting diabetes in women poses a high risk of fetal and maternal adverse results. Despite the developments in quality and access of antenatal care, studies conducted have shown the rise in congenital abnormalities plus prenatal mortality amongst diabetic mothers compared to the background population. Diabetic women also experience delivery through cesarean section, preterm labor, and spontaneous abortion. Diabetes is a global health issue with a projected 300 million people expected to have diabetes by 2030 globally (American Diabetes Association, 2017). In most regions around the world, comprising the Middle East and Western countries, diabetes is considered a major health problem that affects women in the reproductive age. In a study conducted recently, the prenatal mortality amongst mothers having diabetes is four-time greater with the risks of congenital malformation amongst.

Most of the diabetes complications during pregnancy can be avoided through the optimization of maternal health before conception. Glycemic control is among the vital aspects of preconception care. Nevertheless, other elements such as smoking cessation, folic acid supplementations, treatment, and screening of diabetes complications are significant in improving fetal and maternal outcomes (Young-Hyman et al., 2016).Various studies have been done to compare the outcome of women having type 2 diabetes who were counseled before conception with those who never receive the intervention. Clinical trials have demonstrated that pre-conception counseling can advance the metabolic control, as well as female outcomes. Beginning from puberty, the preconception counseling needs to be part of all the routine diabetes clinic visits for every woman who can be pregnant.

Proper data should be provided gradually with frequent reminders over the reproductive life cycle of a woman. Even though some women might receive the first preconception counseling, routine and follow up reminders are vital. For females who intend to get pregnant and receive pre-conception care, both the health professionals and women having diabetes should take precautions (Solomon et al., 2017). These will prevent burnout as it is characterized by extended living with constant stress. The demand on the health care professionals and women having diabetes to maintain and attain euglycemia for the indefinite period can be hectic for the support networks as well as those women.

The relationship between pregnancy outcome and blood glucose is indicative of the value of preconception care. Women who have diabetes and undergo preconception counseling will have lesser fetal and maternal complications and they will need less insulin as compared to the women who lack counseling (Klingensmith et al., 2016). Also, such individuals will have better control of blood sugar for three months before conception and during the first trimester and improved consumption of folic acid. Preconception counseling is a significant solution for the improvement of the overall health of the fetus and the mother. The early prenatal care is mostly provided at the end of the first trimester when the adverse effects of the fetus are considered irreversible. The risks factors are identified before conception during the counseling sessions, and thus the pregnancy can be improved.

Moreover, preconception care program includes proper nutrition, consumption of folic acid supplements, better sugar control, doing exercises, having a consultation with the doctor on congenital abnormalities, and practicing contraception. Since preconception counseling reduces fetal and maternal complications, it needs to be considered as an essential item. Research concerning awareness of women having people with diabetes at reproductive age in connection to the preconception counseling, and designing programs to prevent fetal and maternal complications is essential (Klingensmith et al., 2016). Preconception counseling is a crucial strategy that should be designed for the health improvement of women having diabetes before pregnancy. Researchers have indicated that adequately designed training programs are beneficial in raising awareness among health care providers. Health practitioners can be used to effectively control diabetes complications during pregnancy.

The information generated from experience and views of women having diabetes provide a better understanding of the elements that contribute to the usage of preconception counseling. The effectiveness and uptake of the advice need to be more than just giving information to women concerning the significance of managing their pregnancy and reproduction planning (Chaudhury et al., 2017). While the information might increase the women’s awareness concerning the counseling sessions, the underlying social factors, emotional concerns, and beliefs need to be considered. It is essential to ensure that women are engaged and benefit from the advice. Utilizing various media and multimodal approach, women anxieties and beliefs concerning pregnancy are actively explored before the interventional strategies. It is vital to increase women activation and engagement in connection to reproductive health and this process requires a more motivational and collaborative method of care delivery.

The impact of cultural and social factors on women’s reproductive choices needs to be considered. The interventions might need to consider not just the views of the women but also that of the whole community and family (Chaudhury et al., 2017). Social relationships, particularly between spouses, might be influential. Including preconception counseling may assist the women in adopting protective behaviors by encouraging them to voice their views and beliefs in pregnancy. At a broader level, it might be useful to work with particular communities to assist in promoting their understanding of counseling. Considering the predominance of diabetes in women, such methods might enhance counseling uptake and awareness.

Patient education has a significant role in promoting the understanding of diabetes reproductive health issues. Women have observed that there is a delay between the diabetes diagnoses, a time when they receive advice concerning pregnancy. During this period, women are most vulnerable to unplanned pregnancies. Presently, individuals who are diagnosed with diabetes are provided education, but most of them do not address reproduction. Thus, education strategies after diagnosis and the need to address the border factors linked with the reproductive behaviors in women might be vital. Women have reported that having the first pregnancy can influence future pregnancy planning; hence, it is essential to include personal experience as part of the educational resources.

In conclusion, proper counseling before conception amongst women having diabetes is vital since they are at high risks of fetal and maternal unpleasant results. Studies indicate that preconception counseling can enhance the metabolic control and female outcomes. Recommendations should start from puberty and should be part of all the regular diabetes clinic visits for every woman at childbearing age



American Diabetes Association. (2017). 13. Management of diabetes in pregnancy. Diabetes Care40(Supplement 1), S114-S119. DOI: 10.2337/dc18-S013

Chaudhury, A., Duvoor, C., Dendi, R., Sena, V., Kraleti, S., Chada, A., … & Kuriakose, K. (2017). Clinical review of antidiabetic drugs: Implications for type 2 diabetes mellitus management. Frontiers in Endocrinology8, 6. DOI: 10.3389/fendo.2017.00006

Klingensmith, G. J., Pyle, L., Nadeau, K. J., Barbour, L. A., Goland, R. S., Willi, S. M., … & White, N. H. (2016). Pregnancy outcomes in youth with type 2 diabetes: The TODAY study experience. Diabetes Care39(1), 122-129. DOI: 10.2337/dc15-1206

Solomon, S. D., Chew, E., Duh, E. J., Sobrin, L., Sun, J. K., VanderBeek, B. L., … & Gardner, T. W. (2017). Diabetic retinopathy: A position statement by the American Diabetes Association. Diabetes Care40(3), 412-418. DOI: 10.2337/dc16-2641

Young-Hyman, D., De Groot, M., Hill-Briggs, F., Gonzalez, J. S., Hood, K., & Peyrot, M. (2016). Psychosocial care for people with diabetes: A position statement of the American Diabetes Association. Diabetes Care39(12), 2126-2140. DOI: 10.2337/dc16-2053