PMID- 28398196 OWN - NLM STAT- MEDLINE DCOM- 20180228 LR - 20210109 IS - 2046-4924 (Electronic) IS - 1366-5278 (Print) IS - 1366-5278 (Linking) VI - 21 IP - 14 DP - 2017 Mar TI - Preconception care for women with type 1 or type 2 diabetes mellitus: a mixed-methods study exploring uptake of preconception care. PG - 1-130 LID - 10.3310/hta21140 [doi] AB - BACKGROUND: Diabetes mellitus is a global health problem and one of the most common medical conditions in pregnancy. A wide range of modifiable risk factors are associated with diabetes mellitus in pregnancy, and it is widely acknowledged that preconception care (PCC) is beneficial for women with pre-existing diabetes mellitus. However, uptake of PCC services is low. OBJECTIVES: To systematically review qualitative research on PCC for women with pre-existing diabetes mellitus of childbearing age, identify facilitators of and barriers to uptake of PCC and establish themes and gaps in knowledge. Through qualitative interviews explore views on the provision of, and facilitators of and barriers to the uptake of, PCC. DESIGN: Mixed methods encompassing a systematic review and qualitative interviews. SETTING: Two secondary care sites and 11 primary care sites. PARTICIPANTS: Women of childbearing age with pre-existing type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) of white British or Pakistani origin. INTERVENTIONS: None. ANALYSIS: A narrative synthesis of the literature using thematic analysis and a thematic analysis of the qualitative interview data using the method of constant comparison. RESULTS: Eighteen qualitative studies were included in the systematic review and a quality appraisal was carried out using relevant criteria for qualitative research appraisal, including a narrative summary of study quality. Twelve interviews with women with pre-existing T1DM or T2DM were carried out. This fell short of the original aim of interviewing 48 women owing to challenges in recruitment, especially in primary care. A synthesis of these data shows that uptake of PCC is influenced by a range of factors, including the complexity of pregnancy planning, the skill and expertise of health professionals who provide care to women with diabetes mellitus, the role of health professionals in the delivery of PCC, and the quality of relationships between women and health professionals. LIMITATIONS: Owing to significant challenges with recruitment of participants, particularly in primary care, 12 interviews with women with pre-existing T1DM or T2DM were carried out, which fell short of the a priori sample size. CONCLUSIONS: Reconceptualising PCC to place greater emphasis on pregnancy planning, fertility and contraception would lower some of the existing barriers to uptake of care. It is important to clarify who is responsible for the delivery of PCC to women with pre-existing diabetes mellitus and to ensure that the correct expertise is available so that opportunities for advice giving are maximised. Relationships between women and health professionals should be based on a partnership approach that encourages mutual trust and respect, focusing on positive change rather than negative outcomes. FUTURE WORK: Further research is needed to investigate the views and experiences of stakeholders that commission, design and deliver PCC services for women with pre-existing diabetes mellitus; to explore experiences of women from minority or ethnically diverse backgrounds; to investigate the role of family support in contraception, pregnancy planning and PCC; and to investigate the management of diabetes mellitus in neonatal care and its role in breastfeeding. STUDY REGISTRATION: This study is registered as PROSPERO CRD42014015592 and ISRCTN12983949. FUNDING: The National Institute for Health Research Health Technology Assessment programme. FAU - Earle, Sarah AU - Earle S AD - Faculty of Health and Social Care, The Open University, Milton Keynes, UK. FAU - Tariq, Anisah AU - Tariq A AD - Faculty of Health and Social Care, The Open University, Milton Keynes, UK. FAU - Komaromy, Carol AU - Komaromy C AD - Faculty of Health and Social Care, The Open University, Milton Keynes, UK. FAU - Lloyd, Cathy E AU - Lloyd CE AD - Faculty of Health and Social Care, The Open University, Milton Keynes, UK. FAU - Karamat, M Ali AU - Karamat MA AD - Diabetes & Endocrinology Centre, Heartlands Hospital, Birmingham, UK. FAU - Webb, Jackie AU - Webb J AD - Diabetes & Endocrinology Centre, Heartlands Hospital, Birmingham, UK. FAU - Gill, Paramjit S AU - Gill PS AD - Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK. LA - eng SI - ISRCTN/ISRCTN12983949 GR - 12/185/14/DH_/Department of Health/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Health Technol Assess JT - Health technology assessment (Winchester, England) JID - 9706284 RN - 0 (Blood Glucose) RN - 935E97BOY8 (Folic Acid) SB - IM MH - Blood Glucose MH - Diabetes Mellitus, Type 1/*psychology MH - Diabetes Mellitus, Type 2/*psychology MH - Female MH - Folic Acid/administration & dosage MH - Health Behavior MH - Humans MH - Life Style MH - Patient Acceptance of Health Care/*psychology MH - *Preconception Care MH - Qualitative Research MH - Quality of Health Care MH - Risk Factors MH - State Medicine MH - United Kingdom PMC - PMC5402215 EDAT- 2017/04/12 06:00 MHDA- 2018/03/01 06:00 PMCR- 2017/04/24 CRDT- 2017/04/12 06:00 PHST- 2017/04/12 06:00 [entrez] PHST- 2017/04/12 06:00 [pubmed] PHST- 2018/03/01 06:00 [medline] PHST- 2017/04/24 00:00 [pmc-release] AID - 10.3310/hta21140 [doi] PST - ppublish SO - Health Technol Assess. 2017 Mar;21(14):1-130. doi: 10.3310/hta21140.