Contraception and Pregnancy in Diabetes Mellitus
Contraception and Pregnancy in Diabetes Mellitus
This study seeks to expand upon and update this body of work. It will explore the knowledge
 and understanding women with diabetes have around pregnancy and conception, as well as
 establish how well prepared these women are for a pregnancy. Using this data, we will develop
 better services to inform women with diabetes about the contraception and pregnancy, as well
 inform the development of pre-conception counselling services for women with diabetes. If
 successful, we would anticipate seeing an improvement in performance in future National
 Diabetes in Pregnancy audits.
Worldwide, 44% of pregnancies are unplanned; in the UK 45% of pregnancies and one third of
 births are unplanned. If a woman wants 2 children, she will spend, on average, 5 years trying
 to conceive or being pregnant, and 30 years trying to prevent pregnancy.

 Women with diabetes are known to have 'high-risk' pregnancies. Complications for the mother
 include worsening diabetic control, particularly with increased hypoglycaemia in the 1st
 trimester; deterioration in retinopathy and nephropathy; pre-eclampsia; birth trauma due to
 fetal macrosomia. For the fetus, there are increased risks of congenital abnormalities;
 macrosomia with resultant birth trauma including shoulder dystocia; intrauterine growth
 restriction; miscarriage; still birth; neonatal unit admission and neonatal death.

 NICE guidance (NG3) contains a number of recommendations to prepare women with diabetes for a
 healthy pregnancy, and recommendations to avoid a pregnancy in poorly controlled diabetes; it
 also has recommendations about contraception. However, the National Diabetes in Pregnancy
 Audit 2019 shows that seven out of eight women are not adequately prepared pre-pregnancy, and
 there are still increased numbers of neonatal deaths, stillbirths, congenital anomalies,
 large and small for gestational age babies and neonatal unit admissions, compared to
 pregnancies in women without diabetes.

 The cause for these poor outcomes, despite the NICE guidance, needs to be understood to
 enable pregnancy outcomes to improve. One likely factor is poor patient knowledge about the
 complications associated with pregnancy. One study, undertaken in 2009, showed that only 35%
 of women with diabetes of reproductive age recalled having any discussion about pregnancy,
 and only 25% were aware of any of the risks associated with pregnancy. Another study in women
 with diabetes seen in an antenatal clinic showed that even if a woman was aware of the risks
 associated with diabetes in pregnancy, she often did not attend for pre-conception
 counselling and preparation. The reasons for this were multifactorial, including falling
 pregnant faster than expected, and pervious poor interactions with healthcare professionals.
Inclusion Criteria:

 -  Women aged 18-52 years (reproductive age) who are not currently pregnant

 -  Previous diagnosis of Diabetes Mellitus

 Exclusion Criteria:

 -  Inability to understand and write in the English language

 -  Unable to participate due to other factors, as assessed by the Chief Investigators

 -  A history of gestational diabetes but not diabetes mellitus.

 -  Pregnant women