Patient perception of pre-pregnancy care and family planning among reproductive-age female diabetes mellitus patients in a primary care clinic in Penang, Malaysia

• Published in: Malaysian family physician 2020-11, Vol.15 (3), p.35-42
• Main Authors: Ni, Leow Shing, Shuong, Tang Wei, Sheun, Ee Wei, Piliai, Ramesvari Pararajasingam
• Format: Article
• Language: English
• Subjects: Age groups; Birth control; Clinics; Data collection; Diabetes; diabetes mellitus; Family planning; Females; Health care; Maternal & child health; Methods; Original; Patients; perception; Perceptions; pre-pregnancy clinic; Pregnancy; Primary care; Questionnaires; Sociodemographics
• ISSN: 1985-2274; 1985-207X; 1985-2274

Keywords: Family planning, pre-pregnancy clinic, diabetes mellitus, perception Introduction Preconception care (PPC) is an important interventional approach to improve pregnancy outcomes and the health of future children through identification and modification of biomedical, behavioral and social risk to the mother's health. Based on systemic review and metanalysis, PPC among female diabetic patients has been shown to improve outcome (e.g., to reduce the rates of congenital malformation and of preterm delivery).1 In Malaysia, Diabetes Mellitus (DM) is one of the commonest medical conditions affecting pregnancy2, and is associated with adverse fetal, infant, and maternal outcomes.3,4 A Malaysian study has shown that DM is increasingly prevalent among females (9.1%)2, and that only 23.8% of diabetic patients achieve a treatment target of HbA1c < 6.5%.2 Taking this into account, a significant number of female DM patients in the reproductive age group will conceive in unplanned, suboptimal conditions.5,6 Thus, good preconception care prior to conception, coupled with the provision of effective contraception during the optimization of glycemic control, is a very important part of diabetic care for females of reproductive age.3, 4 To achieve good PPC care in Malaysia, the Malaysian Ministry of Health (MOH) has created several initiatives, such as integrating PPC care in maternal and child health clinics (MCHs) and outpatient departments (OPDs), and aiming to coordinate patient care for high-risk patients between primary health care clinics and tertiary hospitals.7,8 The MOH also provides cheap, affordable and easily available contraceptive services in their MCHs. Unfortunately, despite efforts to promote contraceptive use in Malaysia, use has remained stagnant for 25 years,9 and the use of effective contraception among high-risk female patient stalled at only 38-54%.7 These figures are very low compared to neighboring countries (e.g., Thailand, at 72%).7,9 Based on qualitative studies performed locally and abroad, it appears that the reasons behind the low contraception adoption levels are multifactorial, encompassing not only factors involving not only the patient (knowledge, attitude, practice and sociocultural background) but also the healthcare provider and healthcare system.10-12 In order to further integrate and improve PPC care in our local setting, we set out to explore female DM patients' perception of their own need for contraception in relation to PPC