dromlakhani Screen for pregnancy intention in individuals with preexisting diabetes
STEP 1 — Gather Information
Confirm patient has reproductive potential (age of childbearing potential, not sterilized, not currently pregnant) and visit type (reproductive, diabetes, primary care, or urgent care/ER). Note current contraception use and any known pregnancy plans.
STEP 2 — Rule In / Rule Out
If the patient could become pregnant, proceed to ask the pregnancy intention screening question; if pregnancy is not possible (e.g., postmenopausal, sterilized, or currently pregnant), skip screening and document rationale.
STEP 3 — Classify or Stratify
Ask: “Do you intend to become pregnant in the next year?” If yes → classify as pregnancy intention positive; if no → classify as pregnancy intention negative.
STEP 4 — Decide
If pregnancy intention positive: provide basic counseling on benefits of preconception care (PCC), evaluate contraception needs/family planning referral, and refer for PCC to achieve glycemic and health goals. If pregnancy intention negative: discuss effective contraception options, ensure shared decision‑making, and document contraceptive plan.
Clinical Guardrails / Mimics / Pitfalls
Do not assume pregnancy intention based on age alone; avoid coercive contraception counseling; always use shared decision making; do not delay PCC referral even if pregnancy is not desired now, as intentions may change; do not overlook need for folic acid supplementation and glycemic optimization in those planning pregnancy.
Concrete Clinical Example
A 28‑year‑old woman with type 1 diabetes attends a routine diabetes visit. The clinician confirms she could become pregnant and asks pregnancy intention. She answers “yes.” The clinician provides PCC counseling, refers her to preconception care, optimizes her A1C to <6.5%, prescribes folic acid, and reviews contraception for future use.
Source: Preexisting Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guideline, Endocrine Society/European Society of Endocrinology, 2025, DOI: 10.1210/clinem/dgaf288