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      SUN-636 Gaps in Quality of Delivery of Post-Partum Care in Preconception Counselling for Pregnant Women with Pre-Existing Diabetes at a Large Academic Tertiary Centre

      abstract
      , MBChB 1 , , MD, MSc 1 , , MD, MSc 2
      Journal of the Endocrine Society
      Oxford University Press

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          Abstract

          BACKGROUND: Women with pre-existing diabetes are at increased risk of serious adverse pregnancy outcomes compared with the general maternity population including congenital anomaly, stillbirth and neonatal death. The 2018 Diabetes Canada Clinical Practice Guidelines (DC CPG) on Diabetes in Pregnancy recommend that women with pre-existing diabetes are provided with postpartum and preconception counseling by their diabetes healthcare team, as this is associated with improved maternal and fetal outcomes.

          OBJECTIVE: To evaluate the quality of physican counselling of post-partum management and pre conception advice for women with pre-existing diabetes who receive their intrapartum care at Mount Sinai Hospital Diabetes in Pregnancy Clinic in Toronto Ontario.

          METHODS: Eligible patients were pregnant women with pre-existing Type 1 and Type 2 diabetes who were followed in pregnancy until their 6 weeks postpartum clinic visit. Consecutive baseline chart review of patients between June 2018 - June 2019 was performed to audit documentation of physician counselling of DC CPG recommendations at the 6 week post-partum visit. Key components of the recommendations included: 1) targeting an HbA1c of <7% pre-pregnancy, 2) folic acid supplementation and neural tube defect prevention, 3) weight management and optimization of BMI, 4) contraceptive measures and family planning, 5) information regarding outcomes and risks for mother and baby 6) yearly retinal exam.

          RESULTS: Results of our chart review found that 42% (n=50) of women with pre-existing diabetes who received their intrapartum care at our clinic returned for their 6 week postpartum visit between June 2018-June 2019. Audit of the 6 week post-partum clinic note found that less than 20% of women had physician documentation of counselling on two or more key components of the DC CPG recommendations (1-6).

          CONCLUSION: There is a large gap in women attending postpartum appointments and there are significant gaps in physician documentation of counselling among women with pre-existing diabetes. Further analysis will be conducted in order to determine if there is a patient knowledge gap regarding counselling recommendations and a quality improvement project will be undertaken to close this gap.

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          Author and article information

          Journal
          J Endocr Soc
          J Endocr Soc
          jes
          Journal of the Endocrine Society
          Oxford University Press (US )
          2472-1972
          08 May 2020
          08 May 2020
          08 May 2020
          : 4
          : Suppl 1 , ENDO 2020 ABSTRACTS SCHEDULED FOR THE ANNUAL MEETING OF THE ENDOCRINE SOCIETY – MARCH 28 – 31, 2020 - SAN FRANCISCO, CALIFORNIA (CANCELLED)
          : SUN-636
          Affiliations
          [1 ] University of Toronto, Mount Sinai Hospital, Toronto , ON, Canada
          [2 ] University of Toronto, Women’s College Hospital, Toronto , ON, Canada
          Article
          bvaa046.1500
          10.1210/jendso/bvaa046.1500
          7208803
          7983f2ff-bf58-4408-8341-d2b1254708f5
          © Endocrine Society 2020.

          This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

          History
          Page count
          Pages: 1
          Categories
          Diabetes Mellitus and Glucose Metabolism
          Gestational Diabetes, Diabetes in Pregnancy, and in Utero Exposures
          AcademicSubjects/MED00250

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