Mother-daughter dyadic approach for starting preconception counseling at puberty in girls with diabetes

BACKGROUND Preconception counseling (PC) significantly and inexpensively reduces risks of reproductive-health complications for women with diabetes. Our validated technology-based preconception counseling intervention, READY-Girls, is tailored for female teens with type 1 (T1D) and type 2 (T2D) diabetes and targets decision-making regarding effective family planning and seeking PC. Our teen-focused research was instrumental in changing the American Diabetes Association's Practice Recommendations to specify that preconception counseling should "Start at puberty…". This directive requires support from well-informed mothers of teens. Our goal is to provide both teen girls and their mothers with preconception counseling knowledge, and provide mothers with sex-communication training. Evaluation should focus on mother-daughter dyads. PURPOSE This feasibility study explored mother's and daughter's awareness and knowledge of diabetes and pregnancy, and preconception counseling; and compared mother-daughter responses using dyadic analyses. METHODS A mixed-method design was conducted with 10 mothers of daughters with T1D. Mothers were given READY-Girls intervention and completed knowledge and support questionnaires. Their responses were compared to those of their daughter's who were participating in a large randomized, control intervention trial with READY-Girls. RESULTS The major theme from one-on-one interviews was, "I know nothing about diabetes/pregnancy risks and PC". Mother's and daughter's perceptions of having limited knowledge were confirmed by low knowledge scores. Mothers perceived giving higher levels of support compared to their daughter's perceptions of receiving support. CONCLUSION Mothers can play a vital role in initiating discussions regarding reproductive-health with their daughters and reinforcing preconception counseling. Mother-daughter team approach for starting preconception counseling at puberty in girls with diabetes is feasible. Mother-daughter dyadic analyses can be important to explore possible mediating and moderating roles of mother-daughter communication and support about reproductive health on the relationship between READY-Girls intervention and sustainable outcomes.