Preparing for Pregnancy With Diabetes
Denise Charron-Prochownik finds that early counseling of teens is key
Denise Charron-Prochownik, PhD, RN, CPNP, FAAN
Occupation: Professor, Health Behavior Researcher, University of Pittsburgh
Focus: Diabetes Education, Reproductive Health
ADA Research Funding: Clinical Translational Award
For women with diabetes, starting a healthy family takes a lot of extra planning. Pregnancy itself messes with the body’s hormones—including insulin—and can increase insulin resistance. Hypoglycemia (low blood glucose) hits pregnant women harder and faster, putting mother and fetus at risk. And then there’s high blood glucose.
High blood glucose levels at the moment of conception or in the early weeks of pregnancy can lead to birth defects or miscarriages. That means that it’s important to get A1C levels under control before even trying to conceive—and that unplanned pregnancies are especially risky for women with diabetes. “You can lower your risk for complications by having tight metabolic control starting at conception,” says Denise Charron-Prochownik, a professor at the University of Pittsburgh’s School of Nursing and Graduate School of Public Health. But women need to know this early, she adds, before they become sexually active.
Yet when Charron-Prochownik began her career as a diabetes clinical nurse specialist in the 1980s, she was surprised to find that many young women with diabetes weren’t aware of the risks diabetes poses when it comes to pregnancy, or even that preconception counseling was a possibility. “Thirty years ago, we never spoke to our girls about preconception counseling,” she says. “Most of our focus was on their blood sugars.”
In 1999, Charron-Prochownik was awarded an American Diabetes Association grant to develop a preconception counseling program to educate teens about reproductive health and diabetes. “It’s more than just sex ed—they can get that in school,” she says. “We wanted to let them know how diabetes affects pregnancy, how pregnancy affects diabetes, how diabetes affects sexuality—all of the information women need to plan a pregnancy and prevent an unplanned pregnancy.”
The result was “Reproductive-health Education and Awareness of Diabetes in Youth for Girls,” or READY-Girls, a CD-ROM and booklet targeted at teens. “The underlying message was one of hope: You can have a healthy pregnancy, but you have to plan ahead and you’re going to have to do some extra work,” Charron-Prochownik says.
To study the program’s effectiveness, Charron-Prochownik set up ADA-funded experiments in 1999 and 2002 to see if the information made a difference. The results were positive: The 2002 study showed that the participants given the READY-Girls material were more likely to ask their doctors about preconception counseling and that the cost of the program was more than paid for by its success preventing unplanned pregnancies.
While the results showed that the READY-Girls materials were effective at changing behavior, they also helped convince the team that preconception counseling had to start at puberty. Questionnaires about participants’ sexual history showed that about a quarter of the girls in the study group were sexually active. That meant they were already at risk for unplanned pregnancies.
READY-Girls has become an ADA-approved tool for diabetes health professionals. It’s now been transformed into a DVD, with the focus expanded to both type 1 and type 2 diabetes.
Nearly 15 years after the first study, Charron-Prochownik has been given another ADA grant to do a long-term follow-up. She and her team tracked down and recruited 54 women who took part in the original studies as teens. Some are now moms in their mid-30s. For comparison, they recruited women with diabetes who did not receive READY-Girls. “All along, I wanted to see—did it make a difference? Were they using more effective family planning? Did it make a difference in their pregnancies and babies?” she says.
Preliminary results show that “girls who received preconception counseling early had a higher level of family-planning vigilance. They had a significantly later sexual debut … than the comparison group. And they were using a combination of birth control [methods] more, such as condoms and birth control pills,” Charron-Prochownik says.
Armed with new data on the program’s impact, Charron-Prochownik will be able to make an even more powerful case for starting preconception counseling early. “There were no preconception counseling programs for teens. Now there is,” she says. “I’m so grateful for what the ADA has done: It’s funded a project that has a deliverable. We’re collaborating to disseminate the book and DVD for women to use.”
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