Quality of Medical Care in Diabetic Women Undergoing Fertility Treatment: We should do better

• Published in: Diabetes care Vol. 34; no. 10; pp. 2164 - 2169
• Main Authors: Riskin-Mashiah, Shlomit, Auslander, Ron
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.10.2011
• Subjects: Adolescent; Adult; Biological and medical sciences; Blood Glucose - metabolism; children; Chorionic Gonadotropin - therapeutic use; Clomiphene - therapeutic use; counseling; demographic statistics; Diabetes; Diabetes Mellitus - blood; Diabetes Mellitus - drug therapy; Diabetes. Impaired glucose tolerance; Diabetics; drug therapy; drugs; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Fertilization - physiology; folic acid; Folic Acid - therapeutic use; glycemic control; Health aspects; health services; Humans; Infertility; Infertility - blood; Infertility - drug therapy; marital status; Medical care; Medical sciences; Metabolic diseases; Middle Aged; Miscellaneous; nationalities and ethnic groups; Original Research; Patient outcomes; patients; Preconception Care; Pregnancy; pregnancy outcome; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality management; Retrospective Studies; risk; women; Womens health; Young Adult; Israel; Endocrinopathy; Human; Nutrition; Diabetes mellitus; Metabolic diseases; Care; Medicine; Treatment; Fertility; Quality; Female; Woman; Endocrinology; Public health
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc11-0966

OBJECTIVE: Diabetic women are at increased risk for adverse pregnancy outcomes that can be improved by preconception care. Our goal was to evaluate the quality of medical care in diabetic women who undergo fertility treatment and compare it with the quality of medical care in diabetic women with spontaneous pregnancies. RESEARCH DESIGN AND METHODS: This retrospective study on reproductive-age women undergoing fertility treatment in Clalit Health Services (CHS) used data on fertility treatments, prescription fillings, HbA1c levels, and demographics extracted from CHS computerized systems. The control group comprised women with spontaneous pregnancy. Three quality measures in the periconception period were evaluated: folic acid prescription fillings, evaluation and level of HbA1c, and use of potentially hazardous drugs. RESULTS: There were 230 fertility treatment cycles in 83 diabetic women, and 30 diabetic women had spontaneous pregnancy. Women in the fertility group were older and had fewer children. There were no significant differences in marital status or ethnicity. Regular folic acid use, HbA1c recording, and the percentage of women with HbA1c <7% was similar between women in fertility treatment and those with spontaneous pregnancy (23.9, 57.8, and 31.3% vs. 20.0, 73.3, and 40.0%, respectively). Several women in both groups continued the use of potentially hazardous medication. CONCLUSIONS: The periconception medical care of diabetic women who undergo fertility treatment is suboptimal and no better than that of diabetic women with spontaneous pregnancies. More intensive and targeted counseling regarding the importance of folic acid and glycemic control is needed to optimize periconception care of these diabetic patients.