SOCIODEMOGRAPHIC, COGNITIVE, AND AFFECTIVE ANTECEDENTS TO PREGNANCY PLANNING AMONG WOMEN WITH DIABETES

The prevalence of diabetes mellitus is increasing among women of reproductive age and can elevate risk during pregnancy of fetal malformation, perinatal loss, preeclampsia, preterm birth, and macrosomia. Those risks can be reduced by use of contraception until blood glucose is lowered, but current data suggests that women with diabetes are not consistently engaging in family planning practices. To facilitate the improvement of family planning services for women with diabetes, the goal of this three-paper dissertation was to describe the prevalence, racial and ethnic health disparities, contraceptive behaviors, and contraceptive attitudes of women with diabetes. Aim 1 was to estimate the prevalence of diagnosed diabetes, undiagnosed diabetes, suboptimal preconception glycemic control, and prediabetes among women of reproductive age by race and ethnicity. Aim 2 was to distinguish the effectiveness of contraception used by women with diabetes and evaluate the hypothesis that women with diabetes used less effective contraception than women without diabetes. Aim 1 and Aim 2 were conducted using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), which contained biological and survey data from women aged 24−32 in 2007−2008. Aim 3 was to describe the attitudes of women with diabetes towards using contraception (including attitudes about the benefits, barriers, and self-efficacy related to contraception use), for which primary data collection was conducted at a high-risk obstetrics clinic with postpartum women. In Aim 1, our data supported the hypothesis that diabetes prevalence varied by race and ethnicity. The highest rates of total diabetes, undiagnosed diabetes, prediabetes, and suboptimal preconception glycemic control were found among non-Hispanic black women. In Aim 2, our data supported the hypothesis that women with diabetes would be more likely to use no contraception than their normoglycemic peers. In Aim 3, we found support for the hypothesis that women with diabetes who had a greater perception of contraception’s benefits had greater odds of using procedure/prescription contraception in the postpartum period. Together, the findings from the three papers in this dissertation identified priority populations and promising targets for future intervention development to improve family planning service delivery to women with diabetes.Doctor of Philosoph