OP88 Becoming pregnant after baby loss: improving inter-pregnancy care for women with diabetes: a qualitative exploration of women’s experiences and healthcare professional perspectives

Background

Women with pre-existing type 1 and type 2 diabetes are around four times more likely to experience baby loss: miscarriage, stillbirth, neonatal death, or termination of pregnancy for medical reasons. Careful pre-pregnancy preparation can reduce the risk of baby loss. However, uptake of pre-pregnancy care is low. Approximately 50% of women with diabetes do not prepare for pregnancy – even after experiencing baby loss.

Aims

Explore and better understand: (i) women with diabetes’ experiences of becoming pregnant after baby loss; (ii) healthcare professional perspectives on providing pre-conceptual care to this group.

Key project objective

Develop recommendations for good practice to improve provision of support after baby loss and preparation for future pregnancies among women with diabetes.

Methods

Data were collected November 2020-July 2021. Thirty participants (women with diabetes=12, healthcare professionals=18), recruited through social media and professional networks, took part in a semi-structured telephone/Zoom/Teamsinterview. Data were analysed using Thematic Analysis.

Results

Four main descriptive themes: (1) Decisions around becoming pregnant after baby loss; (2) The multiple burdens of baby loss, diabetes, and planning for pregnancy; (3) Knowledge-, training-, and skills- gaps; (4) Discontinuities in inter-pregnancy care. The inter-pregnancy interval between baby loss and subsequent pregnancy ranged from 2–66 months (average=12 months, median=7 months).

Discussion

All the women with diabetes knew straight away that they wanted to try for another baby, and most wanted to become pregnant as soon as possible. The short inter-pregnancy interval highlighted the small window of opportunity to help women with diabetes both grieve and prepare for pregnancy. Women with diabetes have individualised and sometimes complex healthcare needs. They may face multiplex burdens, which obfuscate their journey to becoming pregnant again. Care provision varies across providers. Primary, community, and secondary care all play a role in ensuring women with diabetes can access the support needed. Gaps in knowledge, training, and skills coupled with unclear referral pathways culminate in a precarious inter-pregnancy interval which is a challenge to navigate. Barriers to education, support, and resources in the inter-pregnancy interval may worsen health inequalities faced by women with type 2 diabetes. Recommendations for good practice, developed in collaboration with healthcare professionals and the baby loss charity, ‘Sands’, include training to equip healthcare professionals with the words and skills to facilitate a sensitive discussion of pregnancy plans. This, along with timely access to pre-pregnancy support, has the potential to reduce the high rate of baby loss in subsequent pregnancy among women with diabetes.