Juggling type 1 diabetes and pregnancy in rural Australia

Objective

to explore the experiences of women with type 1 diabetes, living in rural Australia, while preparing for pregnancy and childbirth. Additionally, we aimed to describe the women's engagement with, and expectations of, health-care providers during this period, and subsequently highlight potential service and informational gaps.

Design

qualitative research using a collective case-study design; seven women with type 1 diabetes who had given birth within the previous 12 months participated in in-depth interviews about their experiences of pregnancy and birth. Data were analysed thematically.

Setting

The experience of type 1 diabetes, preconception preparation and pregnancy among rural Australian women was explored, including interactions with health professionals.

Participants

seven women aged between 26 and 35 years agreed to be interviewed. The woman had one or two children and had given birth within the past 12 months.

Findings

rigid narrow control of blood glucose levels before conception and during pregnancy created unfamiliar body responses for women, with hypoglycaemic symptoms disappearing or changing. For example, some women mentioned developing tunnel vision or numbness and tingling around their lips and tongue as different symptoms of hypoglycaemia. Women needed information and support to differentiate between what might be normal or abnormal bodily processes associated with pregnancy, diabetes, or both. The women's preparation for conception and pregnancy was reliant on the level of available expertise and advice. Participants’ experiences were coloured by their limited access and interactions with expert health professionals.

Conclusion

women with type 1 diabetes experienced significant hardship during their pregnancy, including a higher incidence of hypoglycaemic episodes, a loss of hypoglycaemic symptom recognition and weight gain. These difficulties were compounded by a scarcity of available information to support the management of their pregnancy and a lack of availability of experienced health professionals.

Implications for practice

national and international consensus guidelines emphasise the importance of preconception and pregnancy care for women with type 1 diabetes. Close clinical supervision and the development of closer co-operation and partnership between the women and health-care providers before conception and during pregnancy may improve outcomes for these women and their babies. Building confidence in professional care requires increased access to specialist services, increased levels of demonstrated knowledge and expertise and better general community access to information about preparation for pregnancy and birth among women who have type 1 diabetes.     

Preconception lifestyle changes in women with planned pregnancies

Objectives(1) to study preconception lifestyle changes and associated factors in women with planned pregnancies; (2) to assess the prevalence of risk factors for adverse pregnancy outcomes in women not reporting any preconception lifestyle changes; and (3) to explore the need for and use of preconception-related advice.Designsecondary data analysis of a cross-sectional study about pregnancy planning.Settingsix Flemish Hospitals (Belgium).Participantsfour hundred and thirty women with a planned pregnancy ending in birth.Measurementspreconception lifestyle changes were measured during the first 5 days postpartum using the validated London Measure of Unplanned Pregnancy. The following changes were assessed: folic acid or multivitamin intake, smoking reduction or cessation, alcohol reduction or cessation, caffeine reduction or cessation, eating more healthily, achieving a healthier weight, obtaining medical or health advice, or another self-reported preconception lifestyle change.Findingsmost women (83%) that planned their pregnancy reported ≥1 lifestyle change in preparation for pregnancy. Overall, nulliparous women (OR 2.18, 95% CI 1.23–3.87) and women with a previous miscarriage (OR 2.44, 95% CI 1.14–5.21) were more likely to prepare for pregnancy, while experiencing financial difficulties (OR 0.20, 95% CI 0.04–0.97) or having a lower educational level (OR 0.56, 95% CI 0.32–0.99) decreased the likelihood of preparing for pregnancy. Half of the women (48%) obtained advice about preconception health, and 86% of these women received their advice from a professional caregiver. Three-quarters (77%) of the women who did not improve their lifestyle before conceiving reported one or more risk factors for adverse pregnancy outcomes.Key Conclusions and implications for practicemultiparous women and women of lower socio-economic status were less likely to change their lifestyle before conception. Strategies to promote preconception health in these women need to be tailored to their needs and characteristics to overcome barriers to change. It may be advantageous to reach these women through non-medical channels, such as schools or other community organizations.     

Beliefs about health and illness in women managed for gestational diabetes in two organisations

OBJECTIVE: to explore beliefs about health, illness and health care in women with gestational diabetes mellitus (GDM) managed in two different organisations based on diabetology or obstetrics. DESIGN: an explorative qualitative study using semi-structured interviews. SETTING: clinic A: a specialist diabetes clinic with regular contact with a diabetologist and antenatal care provided by a midwife; clinic B: a specialist maternity clinic providing regular contact with a midwife, a structured programme for self-monitoring of blood glucose and insulin treatment, and a 1-day diabetes class by an obstetrician, a diabetologist, a midwife and a dietician. The clinics were located at two different university hospitals in Sweden. PARTICIPANTS: a consecutive sample of Swedish women diagnosed with GDM; 13 managed in clinic A and 10 managed in clinic B. MEASUREMENT AND FINDINGS: women described their perceptions of as well-being, being healthy and freedom from disease. All respondents reported a delay in the provision of information about GMD and an information gap about GDM and the management of the condition, from diagnosis until the start of treatment at the specialist clinic. Respondents from clinic A expressed fear about future development of type 2 diabetes. Women from clinic B discussed different causes of GDM, and many claimed that health-care staff informed them that GDM was a transient condition during pregnancy. Respondents from clinic A reported a conflict in their treatment of pregnancy and GDM as two different conditions. KEY CONCLUSIONS: beliefs differed and were related to the health-care model chosen. Women with GDM monitored at a specialist maternity clinic believed GDM to be a transient condition during pregnancy only, whereas women monitored at a diabetes specialist clinic expressed fear about a future risk of developing type 2 diabetes. IMPLICATIONS FOR PRACTICE: relevant information about GDM should be provided without delay after initial diagnosis and thereafter repeatedly. It is important to recognise the context of information given on GDM, as it will substantially influence the beliefs and attitudes of women towards GDM as a transient condition during pregnancy or as a potential risk factor for diabetes.     

Preconception care for women with diabetes: is it effective and who should provide it?

The association between hyperglycaemia and congenital malformations was first recognised over 40 years ago and was followed by the development of preconception clinics for women with diabetes. A fresh look at preconception care is needed as many studies were conducted during the late 1970s and early 1980s, before the introduction of regular home blood glucose monitoring and glycosylated haemoglobin assays, and when many patients with diabetes had microvascular complications. Recent observational studies and a meta-analysis suggest preconception care is effective with an approximately threefold reduction in the risk of malformations. There is now a worldwide epidemic of type 2 diabetes, but only few studies of preconception care have included women with type 2 diabetes. Furthermore, few studies have addressed the relationship between preconception care and perinatal morbidity. This article will review the evidence for preconception care in women with diabetes, evaluate different models of preconception care and discuss future strategies.     

Optimizing Preconception Health among Young Women: What Are We Missing?

Study ObjectiveTo evaluate whether receipt of specific preconception counseling topics differs between teen, young adult, and older mothers.Design, Setting, Participants, Interventions, and Main Outcome MeasuresA survey of 291 primarily low-income, minority mothers with young children at pediatric practices in Baltimore, Maryland was conducted. Multivariable logistic regression models generated relative odds of preconception counseling receipt comparing teens (ages 14-19 years) and young adults (ages 20-24 years) to adult women (age ≥25 years) controlling for demographic characteristics, parity, and pregnancy intention.ResultsTeen mothers were less than half as likely to be counseled about taking folic acid, 4 times more likely to be counseled about vaccines, and twice as likely to be counseled about mental health before pregnancy compared with adult mothers.ConclusionAdolescent preventive care might promote some aspects of preconception health, but topics related specifically to pregnancy outcomes might be missed. Because of the high rate of unplanned teen pregnancy in the United States, additional strategies to promote preconception health in this population are warranted.     

Current practice of preconception care by primary caregivers in the Netherlands

Objectives: Over the past decade the value of preconception care (PCC) consultations has been acknowledged. Investments have been made to promote delivery and uptake of PCC consultations in the Dutch primary care setting. We assessed current activities, perceptions and prerequisites for delivery of PCC in primary care. Methods: A questionnaire was compiled and distributed by mail or e-mail among 1682 general practitioners (GPs) and 746 midwives in the Netherlands between 2013 and 2014. Results: The questionnaire was completed by 449 GPs and 250 midwives. While GPs and midwives were frequently asked about preconception risks, explicit requests by patients for a PCC consultation were less frequent. Although caregivers gave information on preconception risk factors, only a minority recommended PCC in the form of a dedicated consultation. Such consultations occurred infrequently. Risk factor assessment varied between GPs and midwives. Respondents’ perceptions of PCC consultations, however, were generally positive. A small proportion believed that PCC medicalised pregnancy, and recognised barriers in actively raising the topic of patients’ pregnancy wishes. More training, staff, promotion of PCC and adequate reimbursement were prerequisites for future delivery. GPs differed in their opinion of whether they or midwives were primarily responsible for PCC consultations. Midwives, however, saw themselves as responsible for providing PCC consultations. Conclusions: Primary care is underserving prospective parents with regards to PCC consultations. Targets to increase delivery of systematic PCC are: (1) promotion during routine care; (2) increased use of tools; (3) increased collaboration among primary caregivers; (4) reduction of caregivers’ negative perceptions; and (5) tailoring PCC consultations to suit women’s preferences.     

Attitudes towards preconception care in Maltese women with type 1 diabetes mellitus

Introduction: The aim of this study was to assess the level of knowledge and awareness related to preconception care among Maltese women of reproductive age with type 1 diabetes mellitus (T1DM). Methods: Thirty-seven T1DM women, aged 12–30 years, were self-administered a questionnaire related to diabetes self-management and preconception care. The participants then underwent an educational intervention and re-took the same questionnaire. Results: Before the intervention, 26 participants (70%) claimed they did not have any knowledge about the preconception care of diabetes. Of the remaining 11 participants, the main reported source of information about diabetes care was the diabetologist (n = 8; 6.7%). The response rate was 70% (26 out of 37 participants completed the questionnaire after the educational intervention). Six of the participants who initially reported no preconception care knowledge claimed an increased awareness after the event. There was a statistically significant increase in the knowledge scores after the intervention. Conclusion: It is evident that there is a lack of awareness of the importance of pre-pregnancy planning to avoid pregnancy-related complications with diabetes. This emphasizes the need for more education and it is imperative for healthcare professionals to address these issues with adolescent female patients.     

Preconception care—when and what: the attitude of Israeli gynaecologists to preconception counseling

Objectives Preconception care is a form of preventive care and its implementation might improve general women’s health as well as improving pregnancy outcome. Our aim was to survey the attitudes of Israeli gynecologists regarding preconception counseling. Methods E mailed questionnaires were sent to gynecologists in an Israeli gynecology network. The questionnaire included two identical sets of questions; one was regarding the care of reproductive aged women who visit their gynecologist for various reasons and the second was regarding the care of women in their first prenatal visit. Answers were scored (from 3-always to 0-never), summed and compared using Chi-square and paired t tests. Results Mean score for the preconception set was significantly lower than the prenatal set 11.3 (62.7%) versus 16.9 (93.7%) respectively, P < 0.001. Folic acid supplementation and genetic screening tests were recommended to most women in 99 and 94% of first prenatal care visit compared to only 42 and 62% of women who were not pregnant (P < 0.001). Conclusions Gynecologists fail to recognize proper opportunities for preconception care. Increased awareness and concrete guidelines concerning timing and content of preconception counseling might be helpful.     

Exploring Dental Care Misconceptions and Barriers in Pregnancy

Abstract: Background: Poor oral health is increasingly linked to adverse pregnancy outcomes, including preterm birth and low‐birthweight infants. Little is known about childbearing women’s experiences in obtaining dental care. The objective of this study was to explore Florida women’s experience of barriers in obtaining dental care before and during their pregnancies. Methods: Study data were derived from a larger data set of a study that examined barriers to prenatal care. One month after giving birth face‐to‐face interviews were conducted with 253 African American women, 18 to 35 years old, who were residents of one of three Florida counties. Interview questions about women’s experiences on obtaining oral health care before and during pregnancy, and recall of guidance about oral health care during prenatal visits were transcribed and analyzed qualitatively. Through subject‐level content analysis, key themes were assessed about the participants’ perspectives on obtaining oral health care before and during pregnancy. Results: Most participants did not obtain dental care and did not recall receiving dental information during prenatal visits. Barriers to dental care included lack of insurance, difficulty in finding a dentist, low priority given to dental care, misconceptions about the safety and appropriateness of dental care during pregnancy, and sporadic anticipatory guidance during prenatal care. Conclusions: Misconceptions about the appropriateness of oral health care during pregnancy may affect women’s access to and use of this care. Given the implications of poor oral health on possible adverse birth outcomes and its larger connection with the general health of mothers and babies, attention to oral health misconceptions and barriers is warranted. (BIRTH 37:4 December 2010)     

Women with pre-existing diabetes and their experiences of maternity care services

Aims and objectives

the aims of the study were to explore the experience of maternity care services used by women whose pregnancy is complicated by pre-existing diabetes, to gain a deeper understanding of service use and to identify aspects of services that women with pre-existing diabetes would like improved.

Background

for women with pre-existing diabetes; pregnancy, birth and the transition to motherhood can be complex and even chaotic. The aim of specialist diabetes care given during pregnancy and delivered by a specialist team of health-care professionals is to optimise pregnancy outcome. However, how health-care professionals within maternity services provide care and support women with pre-existing diabetes during pregnancy and early motherhood has received limited attention.

Design

an exploratory study utilising a grounded theory approach was conducted. Data were collected via in-depth interviews with 20 respondents; one-to-one, dyad and group interviews were undertaken to fully explore issues. Analysis was undertaken by sub-groups of the research team with at least two members working on each of them.

Findings

three themes were identified from interviews: empathic care with care more focused on diabetes not pregnancy; feeling judged by health-care professionals (with nearly all respondents reporting negative encounters of consultation with the specialist team); and the notion of expertise (with respondents reporting feeling frustrated when it seemed health-care professionals did not value their expertise).

Conclusions

the study emphasised the importance of the health-care relationship for pregnant women with pre-existing diabetes. For outcomes to be optimised women need to be able to form open and trusting relationships with the health-care team.

Relevance to clinical practice

this study highlights the need for the health-care team not only to provide physical care to optimise outcome but also supportive care to assist women with pregnancies complicated by diabetes to achieve the best possible physical and emotional health and well-being.     

The effect of a local promotional campaign on preconceptional lifestyle changes and the use of preconception care

Purpose: The objective of this study was to investigate the effect of a local promotional campaign on preconceptional lifestyle changes and the use of preconception care (PCC).

Material and methods: This quasi-comparative study was carried out between February 2015 and February 2016 at a community midwifery practice in the Netherlands. The intervention consisted of a dual track approach (i) a promotional campaign for couples who wish to conceive and (ii) a PCC pathway for health care providers. Questionnaires were collected from a sample of women who received antenatal care during the pre-intervention (n?=?283) and post-intervention (n?=?257) period. Main outcome measures were preconceptional lifestyle changes and PCC use (defined as searching for information and/or consulting a health care provider).

Results: Women who were exposed to the intervention were significantly more likely to make at least one lifestyle change during the preconception period [adjusted OR 1.56 (95% CI 1.02–2.39)]. Women were especially more likely to preconceptionally reduce or quit [adjusted OR 1.72 (95% CI 1.05–2.83)] their alcohol consumption after exposure to the intervention. Although non-significant, it appeared that women who were exposed to the intervention more often prepared themselves for pregnancy by means of independently searching for preconception health information [adjusted OR 1.13 (95% CI 0.77–1.65)] or consulting a health care provider regarding their wish to conceive [adjusted OR 1.24 (95% CI 0.81–1.92)].

Conclusions: Exposure to a local promotional campaign targeted at preconceptional health was associated with improved preconceptional lifestyle behaviours, especially with regard to alcohol consumption, and has the potential to improve the use of PCC.     

Contemporary management of type 1 diabetes mellitus in pregnancy

Type 1 diabetes in pregnancy can result in significant short- and long-term morbidity to both mother and offspring if management is suboptimal. This morbidity imposes a considerable financial and health burden on the individual and society at large. There is currently a significant body of knowledge to offer guidance on optimal obstetric management of the woman with type 1 diabetes. Utilization of appropriate management guidelines preconception and during pregnancy is an effective strategy to limit complications of type 1 diabetes and should therefore become the standard of care. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to describe the features of a type I diabetic patient, to outline the goals of preconception care in this population of patients, to list the potential adverse effects of diabetes in pregnancy, and to summarize a potential strategy for the management of insulin administration in pregnancy.     

Periconceptional CMV infection prevention in Portugal: population subgroup study in a tertiary perinatal care center

Currently in Portugal, universal screening of pregnant women for Cytomegalovirus (CMV) infection is not performed. However, it is recommended to screen all women attending preconception care. We aimed to assess women’s attendance to preconception care and if their serologic status regarding CMV was known and/or investigated in that consultation. In this cross-sectional study, we interviewed 240 women admitted to the obstetrical ward of a hospital in the Metropolitan Area of Porto (Portugal) about their adherence to preconception care and collected data regarding their CMV serologic status and its investigation. We found that 71.3% of the women who attended preconception care were not screened for CMV infection. Among primigravida, the screening rate was only of 30.4% (upper limit of CI 95%: 44.8%). There were no statistically significant differences between the private and public sectors of healthcare. We observed attendance to preconception care is high (73.1%). For the population subgroup of the metropolitan area of Porto, attendance to preconception care is at least 66%, with a 95% confidence level. Portuguese guidelines stating a woman’s serologic status regarding CMV should be investigated in preconception care are not properly implemented. This suggests guidelines should assure the screening of previously non-screened women during pregnancy.     

Preconception care policy,guidelines, recommendations and services across six European countries: Belgium (Flanders), Denmark,Italy, the Netherlands,Sweden and the United Kingdom

Abstract

Objectives Preconception care is important for the screening, prevention and management of risk factors that affect pregnancy outcomes. We aimed to investigate pre-pregnancy care policies, guidelines, recommendations and services in six European countries.

Methods In 2013, an electronic search and investigation was undertaken of preconception policy, guidelines, recommendations and services available to healthcare professionals and the general public in six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom. Findings were compared within five categories: Governmental policy and legislation; Professional bodies and organisations; Healthcare providers; Charitable organisations; Web-based public information and internet sites.

Results All countries had preconception recommendations for women with chronic diseases, such as diabetes and epilepsy. Recommendations for healthy women and men were fragmented and inconsistent. Preconception guidance was often included in antenatal and pregnancy guidelines. Differences between countries were seen with regard to nutritional and lifestyle advice particularly in relation to fish, caffeine and alcohol consumption, and vitamin supplementation.

Conclusions Current guidelines are heterogeneous. Collaborative research across Europe is required in order to develop evidence-based guidelines for preconception health and care. There is a need to establish a clear strategy for promoting advice and guidance within the European childbearing population.

Chinese Abstract

摘要

目的 孕前保健对于那些影响妊娠结局的风险因素的筛查、预防和管理是非常重要的。我们旨在调查六个欧洲国家的孕前保健政策、指南、推荐规范和服务项目

方法 2013年，一项服务于医疗专家和公众的电子搜索和调查项目在六个欧洲国家：比利时（弗兰德斯）、丹麦、意大利、荷兰、瑞典和英国展开。其结果从以下五个方面进行比较：政府政策和立法；专业团队和机构；医务人员；慈善组织；基于网络的公共信息和互联网站。

结果 所有国家对于患有慢性病的女性（如糖尿病和癫痫）均有相应的孕前推荐规范。而对于健康男女的推荐规范则比较分散且不一致。孕前指南常包括在产前和妊娠指南中。各个国家关于营养和生活方式的建议，尤其涉及鱼类、咖啡因、饮酒和维生素补充方面是不同的。

结论 现行的指南多种多样，需要整个欧洲进行合作研究，从而为孕前卫生保健制定循证指南。因此有必要为促进建议和指南在欧洲生育年龄人群中的实施建立清晰的方法。     

The preconception needs of women with severe mental illness: a consecutive clinical case series

Abstract

Introduction: Women with severe mental illness (SMI) are having babies at an increasing rate, but continue to face many challenges across the perinatal period. There is little research into the preconception needs of women with SMI and the aim of this study was to investigate the social circumstances, general health, mental health and reproductive health care needs in these at risk women.

Method: Women with SMI referred for specialist preconception counselling at a tertiary obstetric hospital in 2012 were eligible to participate. The data source was a semi-structured study-specific interview schedule with open-ended questions incorporated into the routine assessment protocol.

Results: In a one-year period, 23 women were referred to the service and 22 consented to data from the interview being pooled for the study. All women were taking at least one psychotropic medication at the time of referral. Overall, 40% (n?=?9) were aged at least 35 years, 36% (n?=?8) smoked cigarettes daily and over half (54.5% n?=?12) reported their body mass index as being in the overweight or obese range. Thematic analysis revealed the importance of maternal desire, and concerns relating to age and biological time pressure, the impact of the illness and medication on pregnancy and motherhood.

Conclusion: Our data indicate that preconception counselling should be routine in the care of women with SMI of reproductive age, and should take into account the potential centrality of motherhood in the woman’s rehabilitation, as well as the complex appraisals of risks, general health and support.     

The oldest gravidas: a review of pregnancy risks in women over 45

As a result of delayed childbearing and increasingly sophisticated assisted reproductive technologies, pregnancy in women aged ≥45 years is becoming more common. Women in this age-group should receive thorough preconception evaluation and counseling about their specific risks in pregnancy. Although many pregnancies in women >45 years old are achieved via assisted reproductive technologies with associated preconception counseling, as many as 45% may be spontaneously conceived. It is therefore important for obstetrician-gynecologists to incorporate education for older women about the risks of pregnancy into routine office visits, and to ask women in this age-group about pregnancy planning. Additionally, many pregnancies in women aged >45 years may be safely managed in a nontertiary care center, avoiding the need for referral and transfer of care to an unfamiliar setting. This review addresses preconception evaluation and counseling, real and perceived risks in older mothers, common pregnancy complications and management of pregnancy in women >45 years old. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be better able to counsel women about the risks of pregnancy for women aged ≥45, evaluate older women for common risk factors that may further increase risk in pregnancy, assess pregnancy complications that are more common in women aged >45, and manage otherwise uncomplicated pregnancies in women in this age-group.     

Women's perceptions of being pregnant and having pregestational diabetes

Objectiveto explore the experiences of White British and South East Asian women with type 1 and type 2 diabetes, and the perceived impact of diabetes on their reproductive health.Designa hermeneutic phenomenological approach was used to explore the perceptions of women with diabetes from two different cultural backgrounds with varied reproductive health experiences. Focus groups and one-to-one interviews were used to elicit women's experiences. An interpretive analytical approach was conducted by two researchers.Settingobstetric and diabetes clinics in three hospital sites in the North West of England.Participantsa purposive sample of 22 women with type 1 or type 2 diabetes of different parity and ethnicity.Findingsthe main themes were relinquishing personal control, pregnancy overshadowed by diabetes and haphazard preconception care.Key conclusionsstrategies should be developed to ensure that whilst safety is maintained, the pregnancy focus is not lost. Women should be supported to optimise their experience as well as clinical outcomes. The convergence of professional roles needs consideration; individual members of multidisciplinary diabetes teams should provide a unique and complementary contribution to care. Preconception care needs to be accessible and responsive to women; this should include recognition of socio-cultural differences.     

Why Do Women Seek Antenatal Care Late? Perspectives From Rural South Africa

Despite the widespread availability of free antenatal care services, most women in rural South Africa attend their first antenatal clinic late in pregnancy and fail to return for any followup care, potentially leading to avoidable perinatal and maternal complications. Using interviews with pregnant women from the rural Hlabisa district of South Africa, we documented perceptions of health and health care during pregnancy and investigated factors shaping the utilization of antenatal care. Our findings indicate that most women in this setting do not perceive significant health threats during pregnancy, and in turn view more than one antenatal care visit as unnecessary. In contrast, women perceive labour and delivery as a time of significant health risks that require biomedical attention, and most women prefer to give birth in a health facility. This paradox, in which health care is important for childbirth but not during pregnancy, is embodied in most women's primary reason for seeking antenatal care in this setting: to receive an antenatal attendance card that is required to deliver at a health facility. Health education programs promoting antenatal care are required to explain the importance of effective antenatal care toward maternal and child health.     

Barriers to Managing Diabetes During Pregnancy: The Perceptions of Health Care Practitioners

Abstract: Background: Uncontrolled pregestational diabetes in pregnancy is associated with an increased risk for a major birth defect and additional adverse pregnancy outcomes. The study objective was to investigate the concerns of health care practitioners who care for women with a history of diabetes during pregnancy and their perceptions of attitudes and barriers to achieving good glycemic control. Methods: Focus groups were conducted with physicians, midlevel practitioners, and certified diabetes educators in Atlanta, Georgia. Practitioners were eligible if they actively practiced, primarily in outpatient facilities in Atlanta, and were neither students nor interns. Six focus groups, two of each practitioner type, were conducted. Results: Practitioners stated that few of their patients planned their pregnancies. Practitioners perceived that pregnant women were concerned primarily about their babies and might not be aware of complications with their personal health. Their perceptions of the greatest barriers to glycemic control for women involved lack of knowledge, lack of access, and attitude. Conclusions: Educating women with diabetes about the importance of using effective birth control until they have achieved good glycemic control can help reduce the risk for adverse pregnancy outcomes. Motivators and barriers for a woman with diabetes to achieve glycemic control before, during, and after pregnancy should be considered when developing approaches to improve outcomes. Helping practitioners know what and how to address the needs of childbearing women with or at risk for diabetes can be beneficial. Additional efforts to increase women’s knowledge about diabetes and pregnancy and to develop effective strategies to encourage women’s achievement and maintenance of glycemic control before, during, and after pregnancy are needed. (BIRTH 38:2 June 2011)