Diabetes (DM) can cause reproductive complications. In women with DM, planning a pregnancy and maintaining metabolic control through Preconception Counseling (PC) and care reduces the incidence of congenital abnormalities from 9% to 2%. The American Diabetes Association recommends that, beginning at puberty, PC be given to all women of childbearing age. However, 2/3rds of diabetic women continue to have unplanned pregnancies. We previously reported that many teens with type 1 DM were sexually active, unaware of PC and these problems, and are at high risk for an unplanned pregnancy. Our team developed a theory-based """"""""Reproductive-health Education and Awareness of Diabetes in Youth for Girls"""""""" (READY-Girls) program tailored specifically for teen women with type 1 DM as a CD and book. The program evaluation showed that either CD or book alone were effective (n2=. 062-.291) in enhancing the short-range outcomes of reproductive health awareness, knowledge, attitudes, and positively influencing intentions of 16-19 yr. olds with type 1 DM to prevent an unplanned pregnancy and seek PC. Although some effects were sustained over 3 months, several attitudes and intentions towards behaviors were not. These results, along with the recent epidemic in type 2 DM, especially among minority female adolescents, emphasize the compelling need for an earlier cost-effective, more individualized, maintenance intervention program that will also include information for teens with type 2 DM. Using a mental models approach, we plan to restructure the program to maximize its efficacy. We will then conduct a multi-site randomized-controlled multi-session study to evaluate the effects of a combined DVD and book intervention with a health professional resource component on long-range cognitive, psychosocial, behavioral and biological outcomes and its cost-effectiveness in 13-<20 year old teens with type 1 or 2 DM. This clinic-based self-administered, stand-alone education program could be a low-cost method of reducing unplanned pregnancies and adverse infant outcomes. Thus setting new standards of practice, focusing on empowering teens with DM to make informed choices, and potentially improving their reproductive health and the health of their future children.
