Preparing for pregnancy with diabetes: A conversation with Denise Charron-Prochownik, PhD
A surprise move across the country led Denise Charron-Prochownik, PhD, RN, CPNP, to develop a preconception counseling program for teens with diabetes that would eventually become a model adopted by the American Diabetes Association.
“I was a registered nurse, and I was very happy being the clinical nurse specialist at Boston Children’s Hospital for the rest of my life,” Charron-Prochownik told Healio. “Then my husband said he was taking a new position in Michigan, and I thought, ‘What do I do?’ My position was already taken there. So I went for my PhD, and that is what led me to research. I never expected it; it all just happened, and I kept taking opportunities and pushing as hard as I could with those opportunities. My professional life is very fulfilled.”
Prochownik, professor and chair of the department of health promotion and development in the School of Nursing at the University of Pittsburgh, is a leader in preconception education and care for adolescent girls and women with diabetes, with a special focus on reproductive health for teens with diabetes. She will receive the 2021 Outstanding Educator in Diabetes award at this year’s American Diabetes Association Scientific Sessions. The award recognizes a distinguished health professional who made outstanding educational efforts in the field of diabetes.
Prochownik’s research emphasis is theory-based intervention studies to enhance cognitive/psychosocial factors that influence health behavior and outcomes among children and adolescents with diabetes. Prochownik conducted several projects in instrumentation, program development and evaluation, and survey designs, and received funding from NIH, the ADA and Eli Lilly to develop, implement and evaluate online education-counseling intervention studies regarding reproductive health and preconception counseling for adolescent and young adult women with diabetes. Her current funded projects target Latina, Native American and Alaskan Native and Native Hawaiian communities.
Healio spoke with Prochownik about her passion for educating adolescent girls with diabetes, her love for the outdoors, and what she would like to ask the Pope.
Healio: What is the defining moment that led you to your field?
Charron-Prochownik: I was a registered nurse and became a diabetes clinical nurse specialist at Boston Children’s Hospital — the first person to have the job — so I had to develop the role. I was there for about 4 years, and we had an adolescent clinic. In clinic, we didn’t mention to the girls about their risks of complications during a pregnancy or preconception counseling. I didn’t know about it and it was not something you did.
I later moved to University of Michigan and began work on my doctorate in public health. I was a project director on a CDC grant about preconception counseling in women with diabetes, and we explored which factors predicted women seeking preconception counseling prior to a pregnancy. We learned that if a health provider told them they could be at risk, and that they could prevent those risks if they had normal blood glucose at conception, they were much more likely to have a healthy pregnancy. They had to seek care before they got pregnant to get themselves in good metabolic control. At that moment, it hit me — all of those missed opportunities with the adolescents in the clinic at Boston Children’s.
That became my passion in life. When do we talk to women about this? Once you reach puberty, you could become pregnant anytime after. All I could think was that it is too late to talk about this once women are “ready” to become pregnant. We have to get this message to adolescent girls. We must prevent unplanned pregnancies and let girls know that they will have to plan their pregnancies. Yet there was no literature or developmentally appropriate programs about this for this young age group.
Healio: What area in diabetes care most interests you right now?
Charron-Prochownik: Preconception care for adolescent girls is my mission. I want these programs available for everyone, for free. I gave our program, READY-Girls, over to the ADA to publish and distribute free online. In one sense, mission accomplished. In another, it must be modified for underrepresented groups. There is a surge of type 2 diabetes and higher risk for developing gestational diabetes among Black, Latina and Indigenous girls. We want to continue to create culturally relevant programs and tailor them to reach these communities.
Healio: What do you think will have the greatest influence on your field in the next 10 years?
Charron-Prochownik: There are two tracks when it comes to diabetes research: care and cure. For the cure track, so much is happening, and I think there will be a cure one day.
In my area of reproductive health, and more broadly behavioral research in diabetes care, many technical advancements have changed diabetes management. We now have continuous glucose monitoring, insulin pump therapy, and even the ability to conduct telemedicine visits. Behavior is attached to all of that, of course, but that is where the field is moving the fastest and it is very exciting.
Healio: Whom do you most admire, and what would you ask if you had 5 minutes with them?
Charron-Prochownik: Pope Francis. I am a lifelong Catholic, and he is our first Jesuit pope, so he is more open and questions everything. I would want to ask him how we can all push for more change to increase diversity and inclusion of all genders and races at all levels, not just in the church, but throughout society. What more can he do, and how can we help? The pandemic has fundamentally changed all of us and underlined how much we are all global partners who can work together for good. This really is our moment.
Healio: What are your hobbies and interests outside of medicine?
Charron-Prochownik: My family is so important to me, and my philosophy is to balance mind, body and spirit. In that vein, I enjoy the outdoors, swimming, biking and gardening. We have a place at Lake George in the Adirondack mountains where we hike and kayak. I also enjoy cross country skiing. Most of all, I enjoy cooking and getting together with family and friends, which we are finally, thankfully, starting to do once again. I look forward to once again going to theaters and concerts, too.