In the United States (U.S.), more than 29 million Americans have diabetes, and approximately one third of new diagnoses are among young adults ages 18-50. Women with diabetes in this age group are at risk of pregnancy complications secondary to elevated blood glucose, including spontaneous abortion, stillbirth, preeclampsia, preterm birth, macrosomia, fetal malformation, and fetal programming for obesity and diabetes later in life. Women with diabetes can reduce these risks by preventing unintended pregnancies with contraception until glycemic control is optimized. However, despite the large and growing population of reproductive age women with diabetes, little data is available about their reproductive health behaviors to inform policy and practice. Guided by Pender's ?Revised Health Promotion Model? and Brown and et al.'s ?Socioeconomic Position and Health among Persons with Diabetes Mellitus? model, the proposed study will describe sociodemographic as well as cognitive and affective antecedents (hereafter referred to as ?attitudinal factors? or ?attitudes?) to contraception use behavior by women with diabetes.
Aim 1 is to conduct an analysis of the National Longitudinal Study of Adolescent to Adult Health (Add Health) data set to provide descriptive statistics about the distribution of diagnosed diabetes, undiagnosed diabetes, and prediabetes (identified with biospecimens) by sociodemographic characteristics, including race/ethnicity, socioeconomic position, health insurance status, and access to health care.
Aim 2 is to use Add Health data to describe contraception use behavior by women with diagnosed diabetes, undiagnosed diabetes, and prediabetes and to test the hypothesis, based on Brown et al.'s theoretical model of health disparities, that sociodemographic characteristics and diabetes status are associated with use of effective contraception. Add Health is a nationally representative U.S. sample that is uniquely suited for analyzing reproductive age women with diabetes and their reproductive health behaviors. To describe attitudes associated with reproductive health behaviors, Aim 3 is to conduct a survey with women with diabetes six weeks postpartum about their attitudes and perceptions of barriers, benefits, self-efficacy and preferences concerning pregnancy planning and contraception. This knowledge is essential for meeting the contraception needs of the growing population of reproductive age women with diabetes.
This project addresses NINR's Innovative Question in Wellness 2-4, ?What are the variables (e.g., biological, behavioral, economic, cultural, genetic, environmental) that interact to influence family member wellness and what interventions are most effective in promoting health outcomes?? Findings from this proposed study are critical for improving prevention of unintended pregnancies among women with diabetes and minimizing the potentially devastating maternal and fetal complications during pregnancy secondary to elevated blood glucose. Understanding sociodemographic and attitudinal risk factors are essential for tailoring and targeting care to women with diabetes with the greatest need for support to achieve their childbearing goals and optimize family wellness.
| Britton, Laura E; Berry, Diane C; Hussey, Jon M (2018) Comorbid hypertension and diabetes among U.S. women of reproductive age: Prevalence and disparities. J Diabetes Complications 32:1148-1152 |
| Britton, Laura E; Hussey, Jon M; Crandell, Jamie L et al. (2018) Racial/Ethnic Disparities in Diabetes Diagnosis and Glycemic Control Among Women of Reproductive Age. J Womens Health (Larchmt) 27:1271-1277 |
