Implementing reproductive life plans for women with pre-existing diabetes

Pregnancy outcomes for women with diabetes are poorer than for those without diabetes with 5 times the background rate of infant morbidity or mortality (1, 2). These adverse outcomes can be reduced or prevented by effective contraception, pregnancy planning and preconception care(3). However, only 30%-40% of women with DM seek preconceptual care and plan the timing of their pregnancies (4,5) There are barriers for both women and HCPs to discussing reproductive plans including time, cost, embarrassment, lack of skills and resources and cultural barriers. A reproductive life plan (RLP) (Figure 1.0) with resources for HCPs and women can facilitate these discussions and improve women’s preconception knowledge, attitudes and practice, thus optimising pregnancy outcomes and experience (6). . Figure 1 Approaches to a Reproductive Life Plan Hypotheses: For women from diverse cultural backgrounds (eg. white Australian, SE Asian, South Asian, Pacific Islander) 1. A RLP is acceptable and feasible to use across different cultural contexts in diabetes services. 2.Implementing a RLP with culturally appropriate resources increases reproductive health knowledge across diverse health literacy. 3.Use of a RLP increases contraceptive use or uptake of preconception healthcare recommendations. 4. Supporting pregnancy planning optimises women’s experiences. Method: 1. Design implementation of RLP, referral pathways and resources with two co-design stakeholder workshops at Eastern Health with endocrinologists, diabetes educators, and women with diabetes. Bimonthly meetings at each site for iterative refinement as per our previous health service implementation (40) . User testing of HP resources. 2 Co-design and user test resources for women across different cultural groups 3. Implement over 3 months including referral to services and resources either printed or via digital and evaluate. i) health and social care providers experiences using mixed methods research ii) women’s experiences through qualitative research plus assessment of changes in knowledge, attitudes and practice at baseline and after 3 months across demographics and literacy. iii) documented uptake by women of preconception care recommendations or of contraception if not planning pregnancy.