The experiences of pregnant women with gestational diabetes mellitus: a systematic review of qualitative evidence

The pioneers of Vietnam's epidemiological transition: an ethnographic study of pregnant women's experiences of gestational diabetes

BACKGROUND

Gestational diabetes mellitus (GDM) is an abnormal glucose metabolism diagnosed during pregnancy that can have serious adverse consequences for mother and child. GDM is an exceptional health condition, as its management serves not only as treatment but also as prevention, reducing the risk of future diabetes in mother and child.

OBJECTIVES

This qualitative study aimed to explore how pregnant women experience and respond to GDM, focusing particularly on the role of the family environment in shaping women's experiences.

METHODS

The research was carried out in Vietnam's Thái Bình province in April-May 2023. We conducted in-depth ethnographic interviews with 21 women with GDM, visiting them in their homes. Our theoretical starting point was phenomenological anthropology, and the data were analysed using a thematic analysis approach.

RESULTS

At the centre of women's experiences was the contrast between GDM as a biomedical and a social condition. Whereas GDM was biomedically diagnosed and managed in the healthcare system, it was often deemed insignificant or non-existent by family members. This made GDM a biomedically present but socially absent health condition. This paradox posed challenges to women's GDM self-care, placing them in pioneering social positions.

CONCLUSIONS

The biomedical presence yet social absence of GDM turned women into pioneers at biomedical, digital, epidemiological, and family frontiers. This article calls for appreciation of pregnant women's pioneering roles and for health systems action to involve women and families in the development of GDM policies and programmes at a time of sweeping global health changes.

Practical Considerations for Using Continuous Glucose Monitoring in Patients with Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is the most prevalent metabolic complication during pregnancy. GDM is associated with adverse perinatal, neonatal, and long-term health consequences. Studies have demonstrated that the use of continuous glucose monitoring (CGM) reduces the incidence of maternal and neonatal complications in pregnant women with type 1 diabetes. Although the use of CGM in GDM has not been well studied, a growing body of evidence is showing potential benefits in the GDM population. This article discusses the advantages and challenges of CGM and provides practical guidelines for using this technology in the GDM population.

Associations between dyadic coping, marital satisfaction, and prenatal depression symptoms among couples with gestational diabetes mellitus

AIMS/BACKGROUND

Coping with gestational diabetes mellitus (GDM) presents significant challenges for pregnant women and their partners, which may result in elevated prenatal depression symptoms. However, research has predominantly centred on pregnant women with GDM, with little involvement of their partners. To understand their dyadic interactions, it is imperative to involve GDM couples in the study. This study aims to examine the interplay between dyadic coping and prenatal depression symptoms among GDM couples and to explore the possible mediating role of marital satisfaction.

DESIGN/METHOD

A cross-sectional study was conducted in Guangzhou, China. A total of 400 couples completed the Dyadic Coping Inventory, Locke-Wallace Marital Adjustment Scale, Edinburgh Postnatal Depression Scale, and sociodemographic data sheet. The actor-partner interdependence mediation model was utilised for dyadic data analysis.

RESULTS

Overall, 13.0% of pregnant women with GDM and 8.3% of partners experienced elevated prenatal depression symptoms. Dyadic coping was directly or indirectly related to their own and partners' prenatal depression symptoms in GDM couples, with marital satisfaction acting as a mediator. Specifically, positive dyadic coping was associated with lower prenatal depression symptoms, while negative dyadic coping exhibited an opposite relationship.

CONCLUSION

The prevalence of elevated prenatal depression symptoms was high in GDM couples. It is important to view pregnant women with GDM and their partners as a dyad of a transactional system in prenatal clinical care. Couple-centred interventions targeting to enhance positive dyadic coping and mitigate negative dyadic coping might be beneficial to prevent and alleviate prenatal depression symptoms.

Relationship between illness perception and self-management behaviors among women with gestational diabetes mellitus in China during the COVID-19 pandemic: A mediating role of depression

OBJECTIVE

Describe the current status of illness perception, depression, and self-management behaviors among women with gestational diabetes mellitus (GDM) during the COVID-19 pandemic, and explore the role of depression in the relationship between illness perception and self-management behaviors among women with GDM.

METHODS

Pregnant women diagnosed with GDM were recruited at the obstetrics clinic of a Grade-A tertiary hospital in Wuhan, through convenience sampling. Self-reported questionnaires including basic information, illness perception, depression, and self-management behaviors were used to collect data from April 2021 to February 2022. Mediation analysis was performed by SPSS Process macro.

RESULTS

Among GDM pregnant women, the mean self-management behaviors score was 73.89 (SD = 12.21), the mean illness perception score was 31.80 (SD = 8.77), and 44.3% had depression scores of 10 or higher. The indirect effect of illness perception on self-management behaviors mediated by depression was significant (path a * b, β = -0.045), accounting for 26.6% of the total effect.

CONCLUSION

GDM pregnant women have a certain negative illness perception of GDM, and the detection rate of depression symptoms is relatively high. The level of self-management behaviors among GDM pregnant women is notably suboptimal and warrants improvement. Depression partially mediates the relationship between illness perception and self-management behaviors. Improving positive illness perception and decreasing depression are important strategies to improve self-management behaviors in women with GDM.

Comparative effectiveness trial of metformin versus insulin for the treatment of gestational diabetes in the USA: clinical trial protocol for the multicentre DECIDE study

INTRODUCTION

Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. Glycaemic control decreases the risk of adverse pregnancy outcomes for the affected pregnant individual and the infant exposed in utero. One in four individuals with GDM will require pharmacotherapy to achieve glycaemic control. Injectable insulin has been the mainstay of pharmacotherapy. Oral metformin is an alternative option increasingly used in clinical practice. Both insulin and metformin reduce the risk of adverse pregnancy outcomes, but comparative effectiveness data from a well-characterised, adequately powered study of a diverse US population remain lacking. Because metformin crosses the placenta, long-term safety data, in particular, the risk of childhood obesity, from exposed children are also needed. In addition, the patient-reported experiences of individuals with GDM requiring pharmacotherapy remain to be characterised, including barriers to and facilitators of metformin versus insulin use.

METHODS AND ANALYSIS

In a two-arm open-label, pragmatic comparative effectiveness randomised controlled trial, we will determine if metformin is not inferior to insulin in reducing adverse pregnancy outcomes, is comparably safe for exposed individuals and children, and if patient-reported factors, including facilitators of and barriers to use, differ between metformin and insulin. We plan to recruit 1572 pregnant individuals with GDM who need pharmacotherapy at 20 US sites using consistent diagnostic and treatment criteria for oral metformin versus injectable insulin and follow them and their children through delivery to 2 years post partum. More information is available at www.decidestudy.org.

ETHICS AND DISSEMINATION

The Institutional Review Board at The Ohio State University approved this study (IRB: 2024H0193; date: 7 December 2024). We plan to submit manuscripts describing the results of each study aim, including the pregnancy outcomes, the 2-year follow-up outcomes, and mixed-methods assessment of patient experiences for publication in peer-reviewed journals and presentations at international scientific meetings.

TRIAL REGISTRATION NUMBER

NCT06445946.

Perceived stress and prenatal depression symptoms among couples with gestational diabetes mellitus: The mediating role of dyadic coping

PROBLEM

No studies have been conducted to examine the relationships between perceived stress, positive/negative dyadic coping, and prenatal depression symptoms in Chinese couples with gestational diabetes mellitus (GDM).

BACKGROUND

GDM is a stressful event for pregnant women and their partners, which may result in clinically significant prenatal depression symptoms in couples.

AIM

This study aims to examine the relationships and differences in perceived stress, positive/negative dyadic coping, and prenatal depression symptoms between Chinese pregnant women with GDM and their partners and to explore the mediating role of positive/negative dyadic coping.

METHODS

A cross-sectional study was conducted in Guangzhou, China, from January to October 2021. 402 pairs of GDM couples completed the questionnaires, including the Edinburgh Postnatal Depression Scale, the Chinese version of the Dyadic Coping Inventory, and the Perceived Stress Scale. Dyadic data was analyzed using the actor-partner interdependence mediation model.

FINDINGS

37.6 % of pregnant women with GDM and 24.6 % of their partners experienced clinically significant prenatal depression symptoms. Depression symptoms in couples mutually influence each other. Perceived stress was directly or indirectly related to their and partners' prenatal depression symptoms in GDM couples, with negative dyadic coping acting as a mediator. Maternal negative dyadic coping was also a partner-mediator.

DISCUSSION

The findings of the present study may provide healthcare professionals with a better understanding of the effect of the interpersonal interaction between the couples as a dyad on prenatal depression symptoms in Chinese context.

CONCLUSION

There were intrapersonal and interpersonal associations among perceived stress, negative dyadic coping, and prenatal depression symptoms in pregnant women with GDM and their partners. It suggests a need for screening clinically significant prenatal depression symptoms and decreasing perceived stress and negative dyadic coping among couples with GDM with a focus on pregnant women with GDM.

The experiences of individuals who have had gestational diabetes: A qualitative exploration

AIM

To qualitatively explore the experiences of individuals with Gestational Diabetes Mellitus (GDM) in Australia, and to recognise opportunities for leveraging digital health to enhance the support of GDM management.

METHOD

A cross sectional online survey assessed the experiences of individuals with GDM, the healthcare system and their digital health usage. Respondents (recruited via a national diabetes registry or social media) were adults receiving GDM care within Australia in the last 5 years, who responded to any of three open-ended questions (n = 815) exploring positive, negative and other GDM experiences. Thematic analysis was utilised, and themes were mapped to the socio-ecological systems framework.

RESULTS

At a system level, themes related to (1) accessibility of care including the value of digital health and the inflexible or inconsistent perception of the (2) implementation of guidelines. At an interpersonal level, themes covered the need for adequate (3) health information provision, and (4) supportive care, as well as highlighting (5) experiences of stigma including a desire for greater awareness of GDM. Individual-level themes included: (6) differential barriers to accessing care; (7) negative emotional burden; (8) internalisation of stigma; (9) dietary freedom and social impact and (10) opportunity for change derived from having GDM.

CONCLUSION

Findings suggest a demand for more supportive, person-centred GDM care, improved information provision and individualised implementation of clinical guidelines. Such mechanisms may support reduced barriers to accessing care or negative psychosocial impacts of GDM. Though not central to the identified experiences, digital health tools may help address the need for optimised GDM care.

Experiences and self-care of pregnant nurses with gestational diabetes mellitus: a qualitative study

BACKGROUND

Pregnant nurses are at high risk of developing gestational diabetes mellitus (GDM), and nurses diagnosed with GDM face challenges in balancing disease management and work, which affects maternal and child health and the quality of care. GDM requires significant changes to lifestyle and physical activity to control blood glucose levels, which is key to reducing adverse pregnancy outcomes. However, few studies have focused on the experiences of pregnant nurses with GDM. This study aimed to gain insight into the experiences of pregnant nurses with GDM in China in terms of their illness, work burdens, and self-care.

METHODS

This qualitative study used an interpretative phenomenological analysis. Face-to-face semi-structured in-depth interviews were conducted with pregnant nurses with GDM to investigate their experiences and self-care. The study was performed at Chongqing's maternal and child health hospital in China. A purposive sampling was used. Nine pregnant nurses diagnosed with GDM were recruited and interviewed.

RESULTS

The interview data generated four themes and 11 sub-themes. The four themes were 'the perceptions and feelings of GDM', 'experiences of lifestyle changes', 'social support needs', and 'health expectations and risk perception.'

CONCLUSION

Many factors such as the unique occupational environment, overwork, occupational pressure, shift work, family status, and education level may lead to difficulties in managing blood glucose in nurses with GDM. These findings suggest that managers should pay more attention to nurses with GDM and develop personalized medical care and work arrangements. These measures can improve the self-care and well-being of nurses with GDM and promote the health of nurses and their offspring.

Effects of women with gestational diabetes mellitus related weight gain on pregnancy outcomes and its experiences in weight management programs: a mixed-methods systematic review

Introduction

Proper controlling gestational diabetes mellitus (GDM)-related gestational weight gain (GWG) during pregnancy can optimize pregnancy outcomes and improve postpartum glucose homeostasis. This study aimed to explore the existing intervention programs, the effects on pregnancy outcomes, and the experiences of weight management for GDM-related GWG in women with GDM.

Methods

This mixed-methods systematic review was retrieved from nine databases. The retrieval time was from the database construction to September 20, 2023, and all studies were published in English and Chinese. The included records used quantitative, qualitative, or mixed methods and reported original studies of weight-related intervention regimens, effects on pregnancy outcomes, and women's experiences and perceptions. This review used a convergent segregated approach to synthesize and integrate research findings from Joanna Briggs Institute (JBI) mixed-methods systematic reviews.

Results

There were 16 articles that met the inclusion criteria, and the articles came from seven different countries and included 23,997 women with GDM. The meta-analysis pooled outcomes for the incidence of weight gain exceeding the Institute of Medicine (IOM) recommendations after GDM diagnosis to delivery was 0.31% (95% CI 0.21-0.42). The effectiveness of GDM-related weight interventions in reducing weight gain after GDM diagnosis was supported by quantitative evidence. The GDM-related GWG below the IOM recommendations is a protective factor (OR=0.68, 95%CI 0.48-0.97) for large for gestational Age (LGA), and above the IOM recommendations is a risk factor (OR=1.62, 95%CI 1.15-2.27) for LGA. In addition, no significant statistical significance was found in the pooled outcomes of small for gestational age (SGA). Avoiding excessive weight gain helps to optimize neonatal birth weight, pregnancy outcomes, and maternal blood glucose levels. According to qualitative survey results, some women with GDM experienced weight stigma, and a positive relationship between healthcare providers and GDM women helped in weight management.

Conclusion

Following a diagnosis of GDM, weight management interventions positively affected GWG and pregnancy outcomes. In order to improve compliance and safety of weight management in women with GDM, criteria and interventions for weight gain associated with GDM need to be further explored and improved.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=404492, identifier CRD42023404492.

Perceptions of primiparous women diagnosed with gestational diabetes mellitus: A descriptive qualitative study

OBJECTIVE

To understand the perceptions of primiparous women recently diagnosed with Gestational Diabetes Mellitus (GDM) in Singapore.

DESIGN

A descriptive qualitative study design.

SETTING

An outpatient women's health clinic in a tertiary hospital in Singapore.

PARTICIPANTS

Twelve English-speaking primiparous women (aged 27-44 years old) who were diagnosed with GDM were recruited via purposive sampling to participate in this study.

METHODS

Face-to-face interviews were carried out with study participants in a private room at the outpatient clinic from December 2019 to May 2021. All interviews were audio-recorded and transcribed verbatim on the same day. Data analysis was guided by Braun and Clarke's thematic analysis framework.

FINDINGS

Four main themes were identified from this study's findings: (1) Life leading to GDM: A 'hint' that something was wrong, (2) Reactions to diagnosis: Shock or acceptance, (3) Learning to cope: Facing internal and external challenges, and (4) Living with GDM: A way forward.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Primiparous women with GDM require comprehensive informational, practical, and emotional support to help them manage and accept their condition. Healthcare providers are encouraged to provide individualised and holistic care to these women using a humanistic approach. Accessible online educational resources and peer support services could be considered. Public campaigns to increase the general public's awareness of GDM would also allow future women and their families to be more familiar with the condition and hence more prepared to cope with it.

Prevalence and contributing factors of impaired awareness of hypoglycemia in patients with type 2 diabetes: a meta-analysis

AIMS

To conduct a systematic review to summarize the definition, measurement tools, prevalence, and contributing factors of impaired awareness of hypoglycemia (IAH) in type 2 diabetes mellitus (T2DM).

METHODS

A reproducible search strategy was used to identify factors affecting IAH in T2DM in PubMed, MEDLINE, EMBASE, Cochrane, PsycINFO, and CINAHL from inception until 2022. Literature screening, quality evaluation, and information extraction were performed independently by 2 investigators. A meta-analysis of prevalence was performed using Stata 17.0.

RESULTS

The pooled prevalence of IAH in patients with T2DM was 22% (95%CI:14-29%). Measurement tools included the Gold score, Clarke's questionnaire, and the Pedersen-Bjergaard scale. IAH in T2DM was associated with sociodemographic factors (age, BMI, ethnicity, marital status, education level, and type of pharmacy patients visited), clinical disease factors (disease duration, HbAlc, complications, insulin therapy regimen, sulfonylureas use, and the frequency and severity of hypoglycemia), and behavior and lifestyle (smoking and medication adherence).

CONCLUSION

The study found a high prevalence of IAH in T2DM, with an increased risk of severe hypoglycemia, suggesting that medical workers should take targeted measures to address sociodemographic factors, clinical disease, and behavior and lifestyle to reduce IAH in T2DM and thus reduce hypoglycemia in patients.

Sleep quality in women with diabetes in pregnancy: a single-center retrospective study

PURPOSE

Sleep quality is an important indicator of individual quality of life, which not only affects people's mental health but is also closely related to the occurrence of many diseases. Sleep disorders associated with diabetes in pregnancy can greatly endanger the health of both mothers and babies, and their hazards are strongly associated with blood glucose levels. This study explored the quality of sleep and sleep disorders in pregnant women with diabetes.

METHODS

From June 2020 to July 2021, a total of 693 patients diagnosed with diabetes during pregnancy in Gansu Provincial Maternal and Child Health Hospital were used as the experiment group, including 626 patients with gestational diabetes mellitus (GDM) and 67 patients with pregestational diabetes mellitus (PGDM). At the same time, 709 women not having diabetes were randomly selected as the control group. To obtain the general situation of the participants, the participants were surveyed using the Pittsburgh Sleep Quality Index (PSQI) and the STOP-BANG (S, Snoring; T, Tiredness; O, Observed apnea; P, high blood Pressure; B, Body mass index > 35 kg/ m2; A, Age > 50 years; N, Neck circumference > 40 cm; G, male Gender) questionnaire. The differences in sleep quality and obstructive sleep apnea-hypopnea syndrome (OSAHS) were analyzed between the experiment group and the control group by using chi-square and t-test, and the clinical features and related factors of sleep disorder were analyzed.

RESULTS

Compared with the control group, the age, pre-pregnancy weight, body mass index (BMI), and neck circumference were larger in the experimental group (P < 0.05). The experimental group had higher PSQI scores for sleep quality, time to fall asleep score, sleep duration, sleep efficiency, sleep disorder, and daytime dysfunction than the control group (all P < 0.001). Specific analysis of the clinical features of sleep disorders indicated that the experimental group scored higher than the control group (P < 0.05). The analysis of the types of daytime dysfunction showed that the experiment group scored higher in terms of frequently feeling sleepy and lack of energy to do things than the control group (P < 0.05). Analysis of STOP-BANG scores indicated that the proportion of patients with GDM or PGDM having fatigue, hypertension, BMI > 35 kg/m2, and neck circumference > 40 cm was higher than that in the control group (P < 0.05). According to regression analysis, sleep quality of patients with GDM was significantly impacted by the increases in age (OR: 1.243, CI:1.197-1.290), neck circumference (OR: 1.350, CI: 1.234-1.476), PSQI score (OR: 2.124, CI:1.656-2.724), and sleep efficiency score (OR: 3.083, CI:1.534-6.195), whereas that of patients with PGDM was impacted by age (OR: 1.191, CI:1.086-1.305), neck circumference (OR: 1.981, CI: 1.469-2.673), and PSQI score (OR: 7.835, CI: 2.383-25.761).

CONCLUSIONS

Pregnant women with diabetes had poorer sleep quality and a higher risk of developing OSAHS than those without diabetes. There may be some link between sleep quality and the onset of diabetic.

Dose-Response Relationship between Gestational Weight Gain and Neonatal Birthweight in Chinese Women with Excess Weight/Obesity and Gestational Diabetes Mellitus

Total gestational weight gain (GWG) is identified as a strong and potentially controllable predictor of long-term health outcomes in women with gestational diabetes mellitus (GDM) and infants. When the total GWG of women with excess weight/obesity and GDM does not exceed the Institute of Medicine (IOM) suggested range, neonatal birthweight outcomes may be favorable, but the evidence is limited. Therefore, the objective of this study was to evaluate the dose-response relationship between increased total GWG and the risk of neonatal birthweight in Chinese women with excess weight/obesity and GDM. This study obtained electronic medical records (EMR) from the hospital information system (HIS) of the Chongqing Health Center for Women and Children between July 2017, and June 2020. A retrospective study analyzed the effect of the total GWG of women with excess weight/obesity and GDM on neonatal birthweight. The dose-response relationship between total GWG and neonatal birthweight was studied using a generalized linear model and embedded restricted cubic splines (RCS). The average age of all women with GDM was 31.99 ± 4.47 years, and 27.61% were advanced maternal age (≥35 years). The total GWG among women with excess weight and obesity and GDM greater than the IOM recommendations were found in 42.96% and 58.62% of cases, respectively. Total GWG in women with excess weight and excessing the IOM recommended range is a risk factor for large gestational age (LGA) [adjusted odds ratio (aOR) 0.1.47, 1.08-2.01] and macrosomia (aOR 1.55, 1.04-2.31). In the obesity above group, excessive weight gain increased the risk of LGA (aOR 2.92, 1.33-6.41) and macrosomia (aOR 2.83, 1.03-7.72). We used an RCS to examine pregnant women with excess weight and GDM and discovered a linear dose-response relationship between total GWG and LGA/macrosomia. In women with excess weight and obesity, increases in total GWG above the lowest end of the IOM recommendations range (7 kg and 5 kg) were associated with an increased risk of LGA and macrosomia. Therefore, research is urgently needed to support maternal and newborn health to provide recommendations for the ideal weight increase in women with excess weight/obesity and GDM.

Ambient air pollution and gestational diabetes mellitus: An updated systematic review and meta-analysis

OBJECTIVE

We aimed to evaluate the relationship between the composition of particulate matter (PM) and gestational diabetes mellitus (GDM) by a comprehensively review of epidemiological studies.

METHODS

We systematically identified cohort studies related to air pollution and GDM risk before February 8, 2023 from six databases (PubMed, Embase, Web of Science Core Collection, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform and Chongqing VIP Chinese Science and Technology Periodical databases). We calculated the relative risk (RR) and its 95% confidence intervals (CIs) to assess the overall effect by using a random effects model.

RESULTS

This meta-analysis of 31 eligible cohort studies showed that exposure to PM_2.5, PM₁₀, SO₂, and NO₂ was associated with a significantly increased risk of GDM, especially in preconception and first trimester. Analysis of the components of PM_2.5 found that the risk of GDM was strongly linked to black carbon (BC) and nitrates (NO₃^-). Specifically, BC exposure in the second trimester and NO₃^- exposure in the first trimester elevated the risk of GDM, with the RR of 1.128 (1.032-1.231) and 1.128 (1.032-1.231), respectively. The stratified analysis showed stronger correlations of GDM risk with higher levels of pollutants in Asia, except for PM_2.5 and BC, which suggested that the specific composition of particulate pollutants had a greater effect on the exposure-outcome association than the concentration.

CONCLUSIONS

Our study found that ambient air pollutant is a critical factor for GDM and further studies on specific particulate matter components should be considered in the future.

Puerperium experience and lifestyle in women with gestational diabetes mellitus and overweight/obesity in China: A qualitative study

Introduction

Women with overweight or obesity and gestational diabetes mellitus (GDM) are at a high risk of developing type 2 diabetes mellitus (T2DM) and other metabolic diseases. Healthy postpartum lifestyles in women with GDM are important for effectively preventing early T2DM occurrence; however, few studies and guidelines focus in China on this issue.

Aims

This qualitative study aimed to understand the puerperium experience and lifestyle of women with overweight/obesity and GDM.

Methods

A face-to-face, in-depth, and semi-structured interview was conducted using a hermeneutical phenomenology method to collect data that were analyzed through thematic analysis.

Results

Out of 61 recruited women with overweight/obesity and history of GDM, 14 women underwent an interview and provided detailed descriptions of their lifestyle experiences during puerperium. The interview data were used to generate four themes—puerperium dietary behavior, weight perception and “confinement” behavior, family support, disease knowledge, and perceived risk—and nine sub-themes.

Conclusion

Unhealthy lifestyles, misconceptions about food, the conflict between physical activity and confinement behavior, a lack of social and family support, and low awareness of disease risk are all common among overweight/obese women with a history of GDM. Thus, we emphasized that healthcare providers should provide continuous preventive care from pregnancy to postpartum and promote long-term health in high-risk populations with a history of GDM associated with overweight/obesity.

The Complexities of Managing Gestational Diabetes in Women of Culturally and Linguistically Diverse Backgrounds: A Qualitative Study of Women's Experiences

AIM

This study aimed to explore women's perspectives and experiences concerning how culture impacts the lifestyle management of gestational diabetes mellitus (GDM) in women of culturally and linguistically diverse (CALD) backgrounds.

METHODS

Women of any cultural background diagnosed with GDM within the previous 12 months were purposively recruited from two Australian metropolitan hospitals. Data collected using semi-structured interviews (n = 18) and focus groups (n = 15 women in three groups) were analysed using reflexive thematic analysis.

RESULTS

Three themes were generated: "cultural beliefs and obligations impact lifestyle management of gestational diabetes", which describes how some cultures lack awareness about GDM, and modifications or restrictions were viewed as depriving the infant, but sometimes adaptions could be made so that a culturally appropriate meal was suitable for GDM management; "the relationship between cultural foods and gestational diabetes management", which discusses how important cultural foods may be incompatible with appropriate GDM management, so women worked to find solutions; "gestational diabetes education lacks cultural awareness and sensitivity", which illustrates how current education fails to address differences in cultural beliefs, language and eating practices.

CONCLUSION

Cultural beliefs, obligations and food practices must be considered when assisting women of CALD backgrounds using lifestyle modification to manage GDM. GDM education must be culturally sensitive and competent and, where possible, be delivered by health professionals of a shared cultural group.

Positive experiences of family caregivers of patients with chronic heart failure: protocol for a qualitative systematic review and meta-synthesis

INTRODUCTION

Previous studies have highlighted the experiences of caregivers for patients with chronic heart failure (CHF), specifically focusing on their negative experiences. There are few systematic reviews on the topic to synthesise the positive experiences of family caregivers for patients with CHF. This study will examine how experiences such as developing new skills, strengthening their relationships (between caregivers and recipients) and receiving appreciation from the care recipient assist to improve caregivers' perception of their circumstances.

METHODS AND ANALYSIS

This review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for qualitative systematic reviews. Qualitative and mixed methods studies related to the positive experiences of family caregivers for patients with CHF, reported in English or Chinese and published from inception in the following databases will be included: PubMed, MEDLINE, Embase, Cochrane Library, Web of Science, PsycINFO, CINAHL, Wan Fang Data, China National Knowledge Infrastructure, Chongqing VIP, Chinese Biomedical Literature Database, Open Grey and Deep Blue Library databases. The standard JBI Critical Appraisal Checklist for Qualitative Research will be used by two independent reviewers to appraise the quality of the included studies, and the standardised JBI Qualitative Data Extraction Tool for Qualitative Research will be applied to extract data. The final synthesised findings will be graded according to the ConQual approach for establishing confidence in the output of qualitative research synthesis.

ETHICS AND DISSEMINATION

Ethical approval is not required as no primary data are being collected. The results will be made available through a peer-reviewed publication.

PROSPERO REGISTRATION NUMBER

CRD42021282159.

A scoping review of gestational diabetes mellitus healthcare: experiences of care reported by pregnant women internationally

Background

Gestational diabetes mellitus (GDM) is a condition associated with pregnancy that engenders additional healthcare demand. A growing body of research includes empirical studies focused on pregnant women’s GDM healthcare experiences. The aim of this scoping review is to map findings, highlight gaps and investigate the way research has been conducted into the healthcare experiences of women with GDM.

Methods

A systematic search of primary research using a number of databases was conducted in September 2021. Studies were included if they had an explicit aim of focusing on GDM and included direct reporting of participants’ experiences of healthcare. Key data from each study was extracted into a purposely-designed form and synthesised using descriptive statistics and thematic analysis.

Results

Fifty-seven articles were included in the analysis. The majority of studies used qualitative methodology, and did not have an explicit theoretical orientation. Most studies were conducted in urban areas of high-income countries and recruitment and research was almost fully conducted in clinical and other healthcare settings. Women found inadequate information a key challenge, and support from healthcare providers a critical factor. Experiences of prescribed diet, medication and monitoring greatly varied across settings. Additional costs associated with managing GDM was cited as a problem in some studies. Overall, women reported significant mental distress in relation to their experience of GDM.

Conclusions

This scoping review draws together reported healthcare experiences of pregnant women with GDM from around the world. Commonalities and differences in the global patient experience of GDM healthcare are identified.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04931-5.

The Perspectives of Diabetes Educators and Dietitians on Diet and Lifestyle Management for Gestational Diabetes Mellitus: A Qualitative Study

This study explores the knowledge and practice of diabetes educators and dietitians on diet and lifestyle management in women with gestational diabetes mellitus (GDM). Diabetes educators and dietitians were recruited from three maternity hospitals in Adelaide (Australia), through snowball and purposive sampling. Thirteen semistructured interviews were conducted, audio recorded, transcribed verbatim, and analysed for codes and themes. Four themes emerged: guidelines and resources, dietary intervention, management delivery, and communication. Diabetes educators and dietitians demonstrated consistent knowledge of nutritional management for GDM and uniform delivery methods. However, a lack of culturally diverse resources was highlighted, along with a lack of continuity of care across the multidisciplinary team. Barriers towards uptake of dietary intervention were reflected by diabetes educators and dietitians as women showing signs of guilt and stress and disengaging from the service. Further exploration on the knowledge and practice of diabetes educators and dietitians for GDM to best inform implementation strategies for knowledge translation of nutritional management is needed. The indication of language and cultural barriers and resources highlight an ongoing key priority area to support the care of women of ethnic minorities.

Association of thyroid disorders with gestational diabetes mellitus: a meta-analysis

PURPOSE

The current meta-analysis aimed to evaluate the association of thyroid dysfunction and autoimmunity with gestational diabetes mellitus (GDM).

METHODS

A comprehensive search from PubMed, Embase, MEDLINE, and Cochrane databases until November 2020 was conducted. Fixed-effect model was used to combine the results when I² was <50%. Random-effect model was used to summarize the results when I² was >50%.

RESULTS

A total of 44 studies were included in the meta-analysis. Low FT4 levels were closely related with GDM in the first and second trimesters of gestation. Hypothyroxinemia (OR: 1.45; 95% CI: 1.25, 1.68; P < 0.00001), overt (OR: 1.80; 95% CI: 1.73, 1.86; P < 0.00001), and subclinical (OR: 1.54; 95% CI: 1.03, 2.30; P = 0.03) hypothyroidism, overt hyperthyroidism (OR: 1.49; 95% CI: 1.09, 2.04; P = 0.01), and positive thyroid antibodies (OR: 1.49; 95% CI: 1.07, 2.07; P < 0.00001) were observed significantly associated with the risk of GDM. Pregnant women with subclinical hyperthyroidism were less likely to develop GDM (OR: 0.62; 95% CI: 0.39, 0.97; P = 0.04).

CONCLUSIONS

Thyroid dysfunction and positive thyroid antibodies were associated with the risk of GDM. Our findings suggest that pregnant women with these thyroid diseases may be offered screening for GDM comprehensively.

Experiences of Changes in Eating Habits and Eating Behaviors of Women First Diagnosed with Gestational Diabetes

As gestational diabetes, which is increasing steadily around the world, can cause complications in the mother and fetus, it is essential to change eating habits and eating behavior to prevent this. According to the 2020 American Diabetes Association recommendations, the food plan should be designed for the adequate calorie intake to achieve glycemic goals and consequently promote maternal and fetal health. Thus, the following study has used the qualitative theme analysis method to assess what it means for 28 South Korean women, who were diagnosed with gestational diabetes for the first time, to change their eating habits and behaviors. As a result, themes were derived related to reflection on daily life, formation of new relationships in the same group, efforts that must be made, rediscovery of couples, and lifestyles reborn as new roles. Based on the results of the study, it is shown that the study participants recovered the peace in their mental state after the crisis of gestational diabetes to pursue relaxation and ultimately higher quality of life by following the plan to fulfill healthy achievements, such as changing their eating habits and behaviors. Therefore, future research and support measures to help the healthy behaviors should be sought by comprehensively exploring the effects of women's experiences in changing their eating habits and behaviors.

Contributing factors of fatigue in patients with type 2 diabetes: A systematic review

Remarkable evidence supports the link between type 2 diabetes (T2DM) and fatigue. However, a unifying recommendation to identify and prevent fatigue or to prevent its clinical consequences in T2DM is not available at present. Therefore, this study aimed to conduct a systematic review to summarize the definition, measurement tools, and contributing factors of fatigue in T2DM. Nine articles were included for analysis, and results showed that T2DM fatigue was associated with five major factors, including sociodemographic factors, clinical disease factors, inflammatory factors, psychological factors, and behavior and lifestyle. The contributing factors of T2DM fatigue are reviewed, and clinical benefits provide a theoretical basis for further clinical intervention to prevent the occurrence of fatigue and improve the patient's treatment compliance and self-management ability and may be beneficial to their quality of life.

Maternal-foetal complications in pregnancy: a retrospective comparison between type 1 and type 2 diabetes mellitus

BACKGROUND

The aim of the study was a retrospective comparison of the differences in maternal-foetal outcomes between women with type 1 and type 2 diabetes mellitus (T1DM and T2DM).

METHODS

A cohort of 135 patients with pregestational diabetes, 73 with T1DM (mean age 29 ± 5 years) and 62 with T2DM (mean age 33 ± 6 years), in intensive insulin treatment throughout pregnancy were evaluated. Clinical and metabolic parameters and the prevalence of maternal and foetal complications were assessed.

RESULTS

Women with T1DM showed lower pregestational BMI (p < 0.001), pregestational weight (p < 0.001), weight at delivery (p < 0.001), ∆_total_insulin requirement (IR) at the first, second and third trimesters (all p < 0.001) and higher weight gain during pregnancy (p < 0.001), pregestational HbA1c (p = 0.040), HbA1c in the first (p = 0.004), second (p = 0.020) and third (p = 0.010) trimesters compared to T2DM. Women with T1DM had a higher risk of macrosomia (p = 0.005) than T2DM, while women with T2DM showed higher prevalence of abortion (p = 0.037) than T1DM. At multivariate analysis, pregestational BMI and ∆_total_IR of the first trimester were independently associated with abortion in T2DM, while weight gain during pregnancy was independently associated with macrosomia in T1DM.

CONCLUSION

Women with T1DM have a higher risk of macrosomia than T2DM due to weight gain throughout pregnancy. By contrast, women with T2DM have a higher risk of spontaneous abortion than T1DM, due to pregestational BMI and ∆_total_IR in the first trimester.

Self-Management Mobile Virtual Reality Program for Women with Gestational Diabetes

The incidence of type 2 diabetes and gestational diabetes shows an increasing trend worldwide, and women diagnosed with gestational diabetes are more likely to develop type 2 diabetes within 5 years of delivery. This is closely related to lifestyle habits such as dietary intake and physical activity; hence, self-management should be continuously practiced. However, after childbirth, women find it challenging to practice self-management due to physical discomfort and child rearing. Therefore, it is necessary to develop an intervention program that is tailored to the characteristics of each participant and allows them to practice self-health management efficiently without time and space restrictions. This study aimed to develop a self-management mobile virtual reality program and investigate its efficacy in preventing type 2 diabetes after childbirth among women diagnosed with gestational diabetes. Intervention with the self-management mobile virtual reality program was performed for 12 weeks. The data of 57 participants in the experimental group and 62 participants in the control group were analyzed. After 12 weeks, the body weight, body fat, hemoglobin A1c, and fasting glucose were decreased in the experimental group compared with the control group. In addition, the dietary habits and health-promoting lifestyle profile were improved in the experimental group compared with the control group. These findings demonstrated that a self-managed mobile virtual reality program could be used as an intervention method for health promotion. To verify the effectiveness of intervention with the self-management mobile virtual reality program, a follow-up study with a larger number of research subjects should be conducted in the future.