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Toledo‐Chavarri A, Delgado J, Rodríguez‐Martín B. Perspectives of women living with type 1 diabetes regarding preconception and antenatal care: A qualitative evidence synthesis. Health Expect 2024; 27:e13876. [PMID: 37909855 PMCID: PMC10726142 DOI: 10.1111/hex.13876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/21/2023] [Accepted: 09/08/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION Pregnant women with type 1 diabetes may have an increased risk of complications for both the baby and themselves. Educational programmes, preconception planning, strict glycemic control and comprehensive medical care are some of the antenatal interventions that have been proposed to improve the outcomes of pregnant women with type 1 diabetes. While some evidence-based recommendations about antenatal care are included in clinical practice guidelines (CPGs), the views, and experiences of women with type 1 diabetes about these interventions are not well known. AIM To understand and synthesize the perceptions of women with type 1 diabetes about the interventions before pregnancy. METHOD A qualitative evidence synthesis (QES) was carried out with a framework analysis guided by the Cochrane Qualitative and Implementation Methods Group approach. Three online databases (Medline, Embase and Web of Science) were searched. We included qualitative articles that were published from 2011 to 2021 and which were available in English or Spanish. FINDINGS Ten references met the inclusion criteria of the study and were included. Three main themes were identified: (a) acceptability of antenatal care, (b) feasibility and implementation consideration and (c) equity and accessibility difficulties. CONCLUSION Continuity of care, coordination between health professionals and services, and a more holistic approach are the key aspects women say need to be considered for more acceptable, feasible and equitable preconception and antenatal care. PATIENT OR PUBLIC CONTRIBUTION This QES was carried out as part of the CPGs on diabetes mellitus type 1, carried out as part of the Spanish Network of Health Technology Assessment Agencies. In this CPG, the representatives of the patient associations are Francisco Javier Darias Yanes, from the Association for Diabetes of Tenerife, who has participated in all the phases of the CPG; Aureliano Ruiz Salmón and Julián Antonio González Hernández (representatives of the Spanish Diabetes Federation (FEDE) who have participated as collaborator and external reviewer, respectively.
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Affiliation(s)
- Ana Toledo‐Chavarri
- Canary Islands Health Research Institute Foundation, (FIISC)TenerifeSpain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS)MadridSpain
- Research Network on Health Services in Chronic Diseases (REDISSEC)Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)Spain
| | - Janet Delgado
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS)MadridSpain
- Department of Philosophy IUniversity of Granada, Campus Universitario de Cartuja CPGranadaSpain
| | - Beatriz Rodríguez‐Martín
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)Spain
- Department of Nursing, Physiotherapy and Occupational TherapyFaculty of Health Sciences, University of Castilla‐La ManchaTalavera de la Reina (Toledo)Spain
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Roddy J, McGowan L. What are the childbearing experiences of women with type 1 diabetes? A scoping review of qualitative literature. Midwifery 2024; 128:103884. [PMID: 37984081 DOI: 10.1016/j.midw.2023.103884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023]
Abstract
PROBLEM Type 1 diabetes is associated with the risk of adverse outcomes for mother and baby. BACKGROUND How pregnant people adapt to the challenges of type 1 diabetes and engage with healthcare professionals can affect how likely they will be to maintain good glycaemic control. Therefore, it is important to understand the childbearing and care experiences of women with type 1 diabetes. AIM To examine contemporary literature describing the childbearing experiences of women with type 1 diabetes over the last decade. METHOD The review follows 5 stages of Arksey and O'Malley's scoping review framework. Four databases were searched for English language publications 2012-2023 using indexed terms and Boolean operators. 64 studies were retrieved, 10 included in the review. Braun and Clarke's thematic synthesis process was used to collate findings. FINDINGS Five key themes emerged: 1. Glycaemic control dominates the childbearing journey, 2. Emphasis on risk, 3. Importance of social and peer support, 4. Care organisation, systems, and communication, 5. The impact of technology on the childbearing experience. CONCLUSION Based on lived experiences, women with type 1 diabetes value being treated as partners in their care by health professionals providing medical and midwifery services. Peer and social support from family, friends and the diabetes community can bring comfort and reassurance in a perceived 'medicalised' childbearing journey. Further research is needed on the impact of the use of type 1 diabetes technologies on childbearing experiences and how peer support can be incorporated into current care provision.
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Affiliation(s)
- Jenny Roddy
- Consultant Midwife Health Equity, Leeds Teaching Hospitals NHS Trust, England, UK.
| | - Linda McGowan
- Professor of Applied Health Research, School of Healthcare, University of Leeds, England, UK
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Haines AJ, Mackenzie L, Honey A, Middleton PG. Occupations and balance during the transition to motherhood with a lifetime chronic illness: A scoping review examining cystic fibrosis, asthma, and Type-1 diabetes. Aust Occup Ther J 2023; 70:730-744. [PMID: 37524324 DOI: 10.1111/1440-1630.12899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 06/30/2023] [Accepted: 07/08/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Throughout the transition to motherhood, changes are experienced across a woman's physical, mental, social, and occupational self. Maternal chronic illness adds the complexity of increased healthcare needs and navigating a high-risk, medicalised pregnancy, birth, and post-natal period. Literature concerning motherhood transitions in chronic illness generally focusses on the mother's medical health and pregnancy outcomes; little is known about the impacts on women's occupations, balance, and quality of life. Understanding these issues may help support women in a more tailored and holistic way. OBJECTIVE This scoping review aims to gather, analyse, and synthesise existing empirical research on occupational engagement and occupational balance as they impact on wellbeing and quality of life in women with a lifetime chronic illness before and during pregnancy and in early motherhood. METHOD The review follows the nine-stage framework described in the Joanna Briggs Institute Manual for Evidence Synthesis (2020). Five databases were searched: Embase, Medline, PsycINFO, CINAHL, Scopus, and OT Seeker. Data were extracted and examined via content analysis, described in narrative synthesis, summarised into a conceptual framework, and tabulated. FINDINGS A total of 8,655 papers were discovered on initial search. Following title and abstract screening, 220 full-text studies were assessed for eligibility, and 46 papers were finally included. Analysis generated four major themes: The Disrupted Transition Journey; Adaptation, Compromise and Choice; Outcomes; and Drawing on What's Available. The themes were conceptualised into a framework to explain how women sought to balance motherhood and illness-related occupations. Adequate access to information, social support, expert care, and financial resources improved both quality of life and healthcare compliance. CONCLUSION Findings of this scoping review deepen the understanding of occupational balance during the transition to motherhood in the context of lifetime chronic illness. Healthcare providers and supportive family and friends can use this knowledge to adapt their approach to assisting women with chronic illness on the motherhood journey. These findings may also inform further inquiry into the scope of occupational therapy practice with this population.
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Affiliation(s)
- Alena Jane Haines
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lynette Mackenzie
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anne Honey
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Peter G Middleton
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Centre for Investigation and Treatment of Respiratory Infections in Children and Adults, Westmead Campus, Westmead, New South Wales, Australia
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Mousavi S, Tannenbaum Greenberg D, Ndjaboué R, Greiver M, Drescher O, Chipenda Dansokho S, Boutin D, Chouinard JM, Dostie S, Fenton R, Greenberg M, McGavock J, Najam A, Rekik M, Weisz T, Willison DJ, Durand A, Witteman HO. The Influence of Age, Sex, and Socioeconomic Status on Glycemic Control Among People With Type 1 and Type 2 Diabetes in Canada: Patient-Led Longitudinal Retrospective Cross-sectional Study With Multiple Time Points of Measurement. JMIR Diabetes 2023; 8:e35682. [PMID: 37104030 PMCID: PMC10176138 DOI: 10.2196/35682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Clinical guidelines for most adults with diabetes recommend maintaining hemoglobin A1c (HbA1c) levels ≤7% (≤53 mmol/mol) to avoid microvascular and macrovascular complications. People with diabetes of different ages, sexes, and socioeconomic statuses may differ in their ease of attaining this goal. OBJECTIVE As a team of people with diabetes, researchers, and health professionals, we aimed to explore patterns in HbA1c results among people with type 1 or type 2 diabetes in Canada. Our research question was identified by people living with diabetes. METHODS In this patient-led retrospective cross-sectional study with multiple time points of measurement, we used generalized estimating equations to analyze the associations of age, sex, and socioeconomic status with 947,543 HbA1c results collected from 2010 to 2019 among 90,770 people living with type 1 or type 2 diabetes in Canada and housed in the Canadian National Diabetes Repository. People living with diabetes reviewed and interpreted the results. RESULTS HbA1c results ≤7.0% represented 30.5% (male people living with type 1 diabetes), 21% (female people living with type 1 diabetes), 55% (male people living with type 2 diabetes) and 59% (female people living with type 2 diabetes) of results in each subcategory. We observed higher HbA1c values during adolescence, and for people living with type 2 diabetes, among people living in lower income areas. Among those with type 1 diabetes, female people tended to have lower HbA1c levels than male people during childbearing years but higher HbA1c levels than male people during menopausal years. Team members living with diabetes confirmed that the patterns we observed reflected their own life courses and suggested that these results be communicated to health professionals and other stakeholders to improve the treatment for people living with diabetes. CONCLUSIONS A substantial proportion of people with diabetes in Canada may need additional support to reach or maintain the guideline-recommended glycemic control goals. Blood sugar management goals may be particularly challenging for people going through adolescence or menopause or those living with fewer financial resources. Health professionals should be aware of the challenging nature of glycemic management, and policy makers in Canada should provide more support for people with diabetes to live healthy lives.
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Affiliation(s)
- Seyedmostafa Mousavi
- Diabetes Action Canada, Toronto, ON, Canada
- VITAM Research Centre in Sustainable Health, Québec, QC, Canada
- Université Laval, Québec, QC, Canada
| | | | - Ruth Ndjaboué
- Diabetes Action Canada, Toronto, ON, Canada
- Centre de recherche sur le Vieillissement, Sherbrooke, QC, Canada
- School of Social Work, Faculty of Letters and Human Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Michelle Greiver
- Diabetes Action Canada, Toronto, ON, Canada
- Department of Family and Community Medicine, North York General Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Selma Chipenda Dansokho
- Diabetes Action Canada, Toronto, ON, Canada
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Denis Boutin
- Diabetes Action Canada, Toronto, ON, Canada
- Centre de recherche du CHUS, Sherbrooke, QC, Canada
| | | | | | - Robert Fenton
- Diabetes Action Canada, Toronto, ON, Canada
- National Indigenous Diabetes Association, Winnipeg, MB, Canada
| | | | - Jonathan McGavock
- Diabetes Action Canada, Toronto, ON, Canada
- Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Monia Rekik
- Diabetes Action Canada, Toronto, ON, Canada
- Department of Operations and Decision Systems, Faculty of Business Administration, Université Laval, Québec, QC, Canada
- Cardiometabolic Health, Diabetes and Obesity Research Network (CMDO), Sherbrooke, QC, Canada
- Interuniversity Research Centre of Enterprise Networks (CIRRELT), Montréal, QC, Canada
| | - Tom Weisz
- Diabetes Action Canada, Toronto, ON, Canada
- Wounds Canada, North York, ON, Canada
- Diabetes Canada, Toronto, ON, Canada
| | - Donald J Willison
- Diabetes Action Canada, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Audrey Durand
- Canada CIFAR AI Chair, Québec, QC, Canada
- Institute Intelligence and Data, Université Laval, Québec, QC, Canada
- Department of Computer Science and Software Engineering, Faculty of Science and Engineering, Université Laval, Québec, QC, Canada
- Department of Electrical Engineering and Computer Engineering, Faculty of Science and Engineering, Faculty of Science and Engineering, Québec, QC, Canada
| | - Holly O Witteman
- Diabetes Action Canada, Toronto, ON, Canada
- VITAM Research Centre in Sustainable Health, Québec, QC, Canada
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Québec, QC, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
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Gu J, Chaput KH, Dunlop A, Booth J, Feig DS, Donovan LE. Existing standardised questionnaires do not adequately capture quality-of-life outcomes of greatest importance for those living with type 1 diabetes in pregnancy. Diabet Med 2023; 40:e15044. [PMID: 36683387 DOI: 10.1111/dme.15044] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND No standardised questionnaires have been specifically developed to assess the considerable demands of managing type 1 diabetes (T1D) during pregnancy. AIMS This study aimed to explore what domains of measurement are important to quality of life during pregnancy with TID and to assess if standardised questionnaires, used by previous researchers, adequately capture patients' reported experience of TID in pregnancy. METHODS A qualitative inquiry was conducted using semi-structured focus groups with Canadian women who have experienced T1D in pregnancy. Participants were asked open-ended questions about experiences managing T1D during pregnancy and whether options on standardised tools captured their pregnancy experiences. Audio from focus groups was transcribed verbatim. Two researchers independently analysed the transcripts using inductive thematic analysis. Salient ideas, experiences and key words were coded iteratively and grouped into broader themes and subsequently reviewed by five participants. RESULTS The sample included nine participants. Emergent themes included changes in day-to-day routines to manage T1D in pregnancy, fear of hyperglycaemia during pregnancy and of hypoglycaemia postpartum. Participants felt that existing options on standardised questionnaires did not adequately quantify diabetes interference in work, family time, planned activities and sleep, and did not address hyperglycaemia fear. CONCLUSIONS Existing standardised questionnaires do not adequately capture patient-reported outcomes of greatest importance for those living with T1D in pregnancy. Future research assessing the impact of therapies on quality-of-life measures in TID pregnancies should quantify their influence on day-to-day activities, adjust measures of sleep quality and capture fear of hyperglycaemia in pregnancy and hypoglycaemia postpartum.
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Affiliation(s)
- Jenny Gu
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kathleen H Chaput
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynaecology and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amy Dunlop
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jane Booth
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Denice S Feig
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
- Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Lois E Donovan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynaecology and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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Riazuelo H. Becoming a mother when suffering from a chronic illness. Front Psychiatry 2022; 13:1059648. [PMID: 36756636 PMCID: PMC9900098 DOI: 10.3389/fpsyt.2022.1059648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/31/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION The critical period of early motherhood when facing serious health problems constitutes a major public health issue. The disease may interfere with, influence, and compound the difficulties experienced over the course of pregnancy and during the parenthood processes. These processes are to be understood as a passage involving so many changes and fraught with difficulties leading to a series of psychological mobilizations. Illness also needs to be considered as a moment of transition, sometimes of severance, marking the lives of the people concerned in a more or less lasting way. Various developments are possible, some of which can be envisaged as leading to more positive outcomes, while others appear as if blocked or doomed to failure. CLINICAL DATA AND METHOD This clinical study is the result of twelve analytically oriented psychotherapeutic follow-ups. The sessions took place weekly over periods ranging from 1 to 6 years. Some of the patients we met had become pregnant while they had a declared but not yet chronic nephropathy. The other patients were already on dialysis and had become mother before starting dialysis. There is also one instance of a pregnant patient on dialysis. In the background, there are also many women who talked about giving up fertility and motherhood. After an in-depth study of each follow-up, a cross-sectional study was conducted to identify the main themes. RESULTS AND DISCUSSION Main considerations on the psychotherapeutic treatment: We regularly observe people who find it impossible to muster the internal resources that would enable them to deal with the trials they undergo in such situations. For the psychologist, there is a need to listen to archaic remnants. Gradually, in the space of psychotherapeutic work, possibilities of "reanimation" of the psyche emerge, an internal space that renews fantasmatic activity as it begins to be able to project into the external space and into the space of the sessions.
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Affiliation(s)
- Hélène Riazuelo
- UFR Sciences Psychologiques et Sciences de l'Éducation (UFR SPSE), Université Paris Nanterre, Nanterre, France.,Nephrology Psychosomatic Unit, Aura Paris Plaisance (APP), Paris, France
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