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Venkatesh KK, Wu J, Trinh A, Cross S, Rice D, Powe CE, Brindle S, Andreatta S, Bartholomew A, MacPherson C, Costantine MM, Saade G, McAlearney AS, Grobman WA, Landon MB. Patient Priorities, Decisional Comfort, and Satisfaction with Metformin versus Insulin for the Treatment of Gestational Diabetes Mellitus. Am J Perinatol 2024; 41:e3170-e3182. [PMID: 38049101 DOI: 10.1055/s-0043-1777334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
OBJECTIVE We compared patient priorities, decisional comfort, and satisfaction with treating gestational diabetes mellitus (GDM) with metformin versus insulin among pregnant individuals with GDM requiring pharmacotherapy. STUDY DESIGN We conducted a cross-sectional study of patients' perspectives about GDM pharmacotherapy in an integrated prenatal and diabetes care program from October 19, 2022, to August 24, 2023. The exposure was metformin versus insulin as the initial medication decision. Outcomes included standardized measures of patient priorities, decisional comfort, and satisfaction about their medication decision. RESULTS Among 144 assessed individuals, 60.4% were prescribed metformin and 39.6% were prescribed insulin. Minoritized individuals were more likely to receive metformin compared with non-Hispanic White individuals (34.9 vs. 17.5%; p = 0.03). Individuals who were willing to participate in a GDM pharmacotherapy clinical trial were more likely to receive insulin than those who were unwilling (30.4 vs. 19.5%; p = 0.02). Individuals receiving metformin were more likely to report prioritizing avoiding injections (62.4 vs. 19.3%; adjusted odds ratio [aOR]: 2.83; 95% confidence interval [CI]: 1.10-7.31), wanting to take a medication no more than twice daily (56.0 vs. 30.4%; aOR: 3.67; 95% CI: 1.56-8.67), and believing that both medications can equally prevent adverse pregnancy outcomes (70.9 vs. 52.6%; aOR: 2.67; 95% CI: 1.19-6.03). Conversely, they were less likely to report prioritizing a medication that crosses the placenta (39.1 vs. 82.5%; aOR: 0.09; 95% CI: 0.03-0.25) and needing supplemental insulin to achieve glycemic control (21.2 vs. 47.4%; aOR: 0.36; 95% CI: 0.15-0.90). Individuals reported similarly high (mean score > 80%) levels of decisional comfort, personal satisfaction with medication decision-making, and satisfaction about their conversation with their provider about their medication decision with metformin and insulin (p ≥ 0.05 for all). CONCLUSION Individuals with GDM requiring pharmacotherapy reported high levels of decision comfort and satisfaction with both metformin and insulin, although they expressed different priorities in medication decision-making. These results can inform future patient-centered GDM treatment strategies. KEY POINTS · Pregnant individuals with GDM requiring pharmacotherapy expressed a high level of decisional comfort and satisfaction with medication decision making.. · Individuals placed different priorities on deciding to take metformin versus insulin.. · These results can inform interventions aimed at delivering person-centered diabetes care in pregnancy that integrates patient autonomy and knowledge about treatment options..
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Affiliation(s)
- Kartik K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Jiqiang Wu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Anne Trinh
- Center for Health Outcomes and Policy Evaluation Studies, The Ohio State University, Columbus, Ohio
| | - Sharon Cross
- Department of Patient Experience, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Donna Rice
- DiabetesSisters, Raleigh, North Carolina
| | - Camille E Powe
- Departments of Medicine and Obstetrics, Gynecology, and Reproductive Biology, Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Brindle
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Sophia Andreatta
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Anna Bartholomew
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Cora MacPherson
- Department of Epidemiology and Biostatistics, George Washington University, Washington, District of Columbia
| | - Maged M Costantine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - George Saade
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical College, Norfolk, Virginia
| | - Ann Scheck McAlearney
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, The Ohio State University, Columbus, Ohio
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Mark B Landon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
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Nisar M, Kolbe-Alexander TL, Khan A. Physical activity and sedentary behaviour among south Asian immigrants in Australia. Health Promot J Austr 2024; 35:57-67. [PMID: 36871190 DOI: 10.1002/hpja.711] [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: 08/31/2022] [Revised: 02/17/2023] [Accepted: 03/03/2023] [Indexed: 03/06/2023] Open
Abstract
ISSUE ADDRESSED South Asians make up the second-largest group of immigrants in Australia and experience a higher burden of chronic diseases compared with non-immigrants. Most chronic diseases are associated with insufficient physical activity (PA) and sedentary behaviour (SB); however, studies involving PA and SB in immigrants are limited. This study aimed to explore PA and SB and associated factors among South Asian immigrants in Australia. METHODS South Asian adult immigrants in Australia were surveyed online (from November 2020 to March 2021) about PA, SB, knowledge and barriers to PA. Logistic regressions were used to examine factors associated with insufficient PA (<150 minutes/week) and a high sitting time (>8 hours/day). RESULTS A total of 321 participants provided complete data. Approximately 76% of participants reported insufficient PA and 27% reported high sitting time. Only 6% of participants walked or bicycled. The main reported barriers to PA were lack of time, costs, transport facilities, skills, and culturally appropriate resources. Around 52% of participants were not aware of the importance of PA. Participants with self-reported poor health and who used motorized travel were more likely to have inadequate PA. High sitting time was more common among middle-aged, overweight/obese, and middle-income participants. CONCLUSIONS Most South Asian immigrants are insufficiently active with a lack of socio-economically appropriate PA facilities identified as a major challenge. A stronger collaboration between policymakers and community is required for sustainable solutions. SO WHAT?: Affordable and appropriate PA facilities in neighbourhoods could overcome major barriers. Also, information about PA should incorporate cultural expectations in the general recommendations to encourage participation.
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Affiliation(s)
- Mehwish Nisar
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Tracy L Kolbe-Alexander
- School of Health and Medical Sciences, and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Asaduzzaman Khan
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
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Sohmaran C, Bte Mohamed Rahim A, Chua JYX, Shorey S. Perceptions of primiparous women diagnosed with gestational diabetes mellitus: A descriptive qualitative study. Midwifery 2023; 125:103802. [PMID: 37657131 DOI: 10.1016/j.midw.2023.103802] [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: 02/17/2023] [Revised: 08/13/2023] [Accepted: 08/25/2023] [Indexed: 09/03/2023]
Abstract
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.
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Affiliation(s)
- Chithrra Sohmaran
- Nursing Division, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore
| | - Asmira Bte Mohamed Rahim
- Nursing Division, Obstetric Day Assessment Centre, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore
| | - Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Abubakari A, Bukari M, Malechi H, Garti H, Agbozo F. I got frightened and felt strange. I even cried a lot after the diagnosis; the experiences on the screening and management of gestational diabetes mellitus among diagnosed women. BMC Res Notes 2023; 16:236. [PMID: 37770971 PMCID: PMC10540323 DOI: 10.1186/s13104-023-06494-w] [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: 01/13/2023] [Accepted: 09/03/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Understanding the experiences of women diagnosed with Gestational Diabetes Mellitus (GDM) can improve screening, management, and postpartum care. Therefore, this study sought to investigate experiences on the screening and management of GDM among diagnosed women. METHODS This was a facility-based explorative qualitative design among five purposively sampled women diagnosed with GDM who were receiving care from healthcare professionals. Women were asked about their reaction to being diagnosed with GDM, their experiences with care, training, self-monitoring, and challenges with the management of GDM, and data obtained were analysed using thematic analysis. RESULTS Based on the thematic analysis, three main themes and ten sub-themes were generated. They were emotional experience (prior information on GDM before being diagnosed, and feelings about the diagnosis and blood glucose measurement), information source and care experience (source of information on healthy diet, training on blood glucose measurement, experiences with follow-up, and general impressions on GDM care), and dietary and lifestyle experience ( perceptions on dietary approaches, difficulties in getting and adhering to dietary and lifestyle guidelines, alternative treatment methods patronized, and effectiveness of dietary and lifestyle approaches). CONCLUSION The themes generated had psycho-emotional underpinning, and underscores the importance of psychotherapy when disclosing disease status and initiating medical care. The findings of this study could be important for the optimisation of GDM care and services for affected women.
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Affiliation(s)
- Abdulai Abubakari
- Department of Global and International Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Mohammed Bukari
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana.
- Department of Social and Behavioral Change, School of Public Health, University for Development Studies, Tamale, Ghana.
| | - Hawa Malechi
- Department of Obstetrics and Gynaecology, Tamale Teaching Hospital, P.O. Box TL 16, Tamale, Ghana
- Department of Obstetrics and Gynaecology, School of Medicine, University for Development Studies, Tamale, Ghana
| | - Humphrey Garti
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Faith Agbozo
- Heidelberg Institute of Global Health, Heidelberg University, 69120, Heidelberg, Germany
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Allied Health Sciences, Private Mail Box 31, Ho, Ghana
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He LR, Yu L, Guo Y. Birth weight and large for gestational age trends in offspring of pregnant women with gestational diabetes mellitus in southern China, 2012-2021. Front Endocrinol (Lausanne) 2023; 14:1166533. [PMID: 37214242 PMCID: PMC10194652 DOI: 10.3389/fendo.2023.1166533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/17/2023] [Indexed: 05/24/2023] Open
Abstract
Background With increasing prevalence of gestational diabetes mellitus (GDM) and changing management of GDM in pregnancy, it is imperative to understand the evolution of its current outcomes. The present study aimed to explore whether birth weight and large for gestational age (LGA) trends in women with GDM have changed over time in southern China. Methods In this hospital-based retrospective study, all singleton live births for the period 2012 to 2021 were collected from the Guangdong Women and Children Hospital, China. GDM was diagnosed following the criteria of the International Association of Diabetes and Pregnancy Study Group. The cutoff points for defining LGA (>90th centile) at birth based on INTERGROWTH-21st gender-specific standards. Linear regression was used to evaluate trends for birth weight over the years. Logistic regression analysis was used to determine the odds ratios (ORs) of LGA between women with GDM and those without GDM. Results Data from 115097 women with singleton live births were included. The total prevalence of GDM was 16.8%. GDM prevalence varied across different years, with the lowest prevalence in 2014 (15.0%) and the highest prevalence in 2021 (19.2%). The mean birth weight displayed decrease in women with GDM from 3.224kg in 2012 to 3.134kg in 2021, and the z score for mean birth weight decreased from 0.230 to -0.037 (P for trend < 0.001). Among women with GDM, the prevalence of macrosomia and LGA reduced significantly during the study period (from 5.1% to 3.0% in macrosomia and from 11.8% to 7.7% in LGA, respectively). Compared to women without GDM, women with GDM had 1.30 (95% CI: 1.23 - 1.38) times odds for LGA, and the ORs remained stable over the study period. Conclusions Among offspring of women with GDM, there are decreased trends of birth weight in parallel with reductions in LGA prevalence between 2012 and 2021. However, the risk of LGA in women with GDM remains stable at relatively high level over the 10-year period, and efforts are still needed to address regarding causes and effective intervention strategies.
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Affiliation(s)
- Li-Rong He
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China
| | - Li Yu
- Department of Children’s Health Care, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yong Guo
- Department of Children’s Health Care, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China
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Haigh C, Lau HWR, Weir T, Glastras S. The experiences of women from culturally and linguistically diverse backgrounds with gestational diabetes mellitus: A mixed methods systematic review. Endocrinol Diabetes Metab 2023:e421. [PMID: 37139646 DOI: 10.1002/edm2.421] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/27/2023] [Accepted: 03/25/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is experienced at a higher rate in women from culturally and linguistically diverse (CALD) backgrounds. The aim of this systematic review is to describe the experiences of women with GDM from CALD backgrounds and compare their experiences to women with GDM from non-CALD backgrounds. MATERIALS AND METHODS MEDLINE, EMBASE, PsycINFO, Scopus, WOS and CINAHL databases were searched for qualitative and quantitative studies which included data on the experiences of CALD background women with GDM during all stages of pregnancy. Quality appraisal utilized checklists for analytical cross-sectional studies and qualitative research. Thematic analysis was performed using nVivo software. RESULTS Of the 3054 studies identified, 24 studies met the inclusion criteria. Data synthesis produced five key themes: (1) Response to diagnosis, (2) Experiences with self-management, (3) Interactions with the healthcare system, (4) Mental health challenges and (5) Facilitators and barriers to support. Women with GDM from CALD and non-CALD backgrounds similarly expressed mental health challenges, feeling burdened by recommendations, and challenges interacting with healthcare professionals (HCP). The major difference in experience was the cultural relevance of recommendations, especially related to diet recommendations. CONCLUSION Gestational diabetes mellitus is a burdensome diagnosis for CALD and non-CALD women, with CALD women uniquely experiencing a lack of culturally relevant recommendations for self-management. The similarities and differences in experience call for optimisation of GDM management and support for women with GDM.
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Affiliation(s)
- Claire Haigh
- Kolling Institute and North Precinct, The University of Sydney, Sydney, New South Wales, Australia
| | - Hiu Wing Rachel Lau
- Kolling Institute and North Precinct, The University of Sydney, Sydney, New South Wales, Australia
| | - Tessa Weir
- Kolling Institute and North Precinct, The University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Sarah Glastras
- Kolling Institute and North Precinct, The University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Tzotzis L, Hooper ME, Douglas A, Kurz E, Atchan M, Spiller S, Davis D. The needs and experiences of women with gestational diabetes mellitus from minority ethnic backgrounds in high-income nations: A systematic integrative review. Women Birth 2023; 36:205-216. [PMID: 36038477 DOI: 10.1016/j.wombi.2022.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) represents a growing challenge worldwide, with significant risks to both the mother and baby that extend beyond the duration of the pregnancy and immediate post-partum period. Women from ethnic minority groups who access GDM care in high-income settings face particular challenges. The aim of this systematic integrative review is to explore the experiences and needs of women with GDM from select ethnic groups in high-income healthcare settings. METHODS For the purposes of this systematic integrative review, a comprehensive search strategy explored the electronic databases CINAHL, Medline, Web of Science, and Scopus were searched for primary studies that explored the needs and experiences of women with gestational diabetes from select ethnic minority groups living in high-income nations. The ethnicity of the women in the study included: East, South and Southeast Asian, Indian subcontinent, Aboriginal/First Nations, Torres Strait Islander, Pacific Islander, Māori, Middle Eastern, African, or South/Latina American. Studies were assessed with the Crowe Critical Appraisal Tool and findings were synthesised with thematic analysis. RESULTS This review included 15 qualitative studies, one mixed method, and one cross-sectional study. Six high-income nations were represented. The voices and experiences of 843 women who originated from at least one ethnic minority group are represented. Four major themes were constructed: psychological impact of GDM, GDM care and education, GDM and sociocultural impact, and GDM and lifestyle changes. DISCUSSION AND CONCLUSION Limitations exist in the provision of culturally appropriate care to support the management of GDM in women from select ethnic groups in high-income healthcare settings. Women require care that is culturally appropriate, considering the individual needs and cultural practices of the woman. Engaging a woman's partner and family ensures good support is provided. Culturally appropriate care needs to be co-designed with communities so that women are at the centre of their care, avoiding a one-size-fits-all approach.
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Affiliation(s)
- Louise Tzotzis
- School of Nursing, Midwifery and Public Health, University of Canberra, Australia
| | - Mary-Ellen Hooper
- School of Nursing, Midwifery and Public Health, University of Canberra, Australia
| | - Angela Douglas
- School of Rehabilitation and Health Sciences, University of Canberra, Australia
| | - Ella Kurz
- School of Nursing, Midwifery and Public Health, University of Canberra, Australia
| | - Marjorie Atchan
- School of Nursing, Midwifery and Public Health, University of Canberra, Australia
| | | | - Deborah Davis
- School of Nursing, Midwifery and Public Health, University of Canberra, Australia; ACT Government Health Directorate, Australia.
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Nar M, Ozcirpan CY. Exploring psychosocial adaptation to pregnancy in women with gestational diabetes. Contemp Nurse 2023:1-11. [PMID: 36734366 DOI: 10.1080/10376178.2023.2175699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. Diagnosis of GDM, that could be unexpected, may cause women to feel negative emotions such as fear, guilt, sadness, and loss of control and experience difficulties adapting to pregnancy.Objective: This study aimed to explore psychosocial adaptation to pregnancy in women with GDM.Methods: This observational cross-sectional study was conducted with women with GDM and healthy pregnant women who applied to the pregnancy and perinatology outpatient clinic of a university hospital. Groups were matched according to age, education level, and gestational week. The Prenatal Self-Evaluation Questionnaire (PSEQ) was used to collect data. Simple linear regression was performed to determine factors influenced psychosocial adaptation to pregnancy using average scores from the PSEQ.Results: Regression analysis indicated, GDM status (beta = -48.8, p ≤ 0.001) and smoking status during pregnancy (beta = 11.0, p = 0.032) influenced the total score of the PSEQ.Conclusions: Nurses are encouraged to develop a multifaceted nursing care model that considers the physical and psychosocial problems and to provide care to increase the psychosocial adaptation of women with GDM to pregnancy.
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Affiliation(s)
- Makbule Nar
- Obstetrics and Gynecology Department, Hacettepe University Adult Hospital, Ankara Turkey
| | - Cigdem Yucel Ozcirpan
- Obstetrics and Gynecology Nursing Department, Hacettepe University, Faculty of Nursing, Ankara, Turkey
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Supports and Barriers to Lifestyle Interventions in Women with Gestational Diabetes Mellitus in Australia: A National Online Survey. Nutrients 2023; 15:nu15030487. [PMID: 36771195 PMCID: PMC9921280 DOI: 10.3390/nu15030487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) affects approximately one in six pregnancies, causing a significant burden on maternal and infant health. Lifestyle interventions are first-line therapies to manage blood glucose levels (BGLs) and prevent future cardiometabolic complications. However, women with GDM experience considerable barriers to lifestyle interventions; thus, the aim of this study was to determine how women with GDM manage their condition and to identify the primary supports and barriers to lifestyle intervention participation. METHODS An online cross-sectional survey of women in Australia with a history of GDM was conducted. Questions included participant demographics, strategies used to manage BGLs, physical activity and dietary habits, and barriers and supports to lifestyle interventions. RESULTS A total of 665 individuals consented and responded to the advertisement, of which 564 were eligible and provided partial or complete responses to the survey questions. Most respondents were between 35 and 39 years of age (35.5%), not pregnant (75.4%), working part-time (26.7%), university-educated (58.0%), and had only one child (40.1%). Most respondents managed their BGLs through diet (88.3%), with "low-carbohydrate" diets being the most popular (72.3%), and 46.2% of respondents were undertaking insulin therapy. Only 42.2% and 19.8% of respondents reported meeting the aerobic and strengthening exercise recommendations, respectively. Women with one child or currently pregnant expecting their first child were 1.51 times more likely (95% CI, 1.02, 2.25) to meet the aerobic exercise recommendations than those with two or more children. The most common reported barriers to lifestyle intervention participation were "lack of time" (71.4%) and "childcare" commitments (57.7%). Lifestyle interventions delivered between 6 and 12 months postpartum (59.0%), involving an exercise program (82.6%), and delivered one-on-one were the most popular (64.9%). CONCLUSION Most women report managing their GDM with lifestyle strategies. The most common strategies reported involve approaches not currently included in the clinical practice guidelines such as reducing carbohydrate consumption. Furthermore, despite being willing to participate in lifestyle interventions, respondents report significant barriers, including lack of time and childcare commitments, whereas mentioned supports included having an online format. Lifestyle interventions for women with a history of GDM should be designed in a manner that is both tailored to the individual and considerate of existing barriers and supports to participation.
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Offomiyor FA, Rehal S. Exploring the Knowledge, Attitude, and Practices of Healthy Pregnant Women Towards Gestational Diabetes Mellitus in Nigeria. QUALITATIVE HEALTH RESEARCH 2023; 33:39-52. [PMID: 36409078 PMCID: PMC9827495 DOI: 10.1177/10497323221139105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Gestational Diabetes Mellitus (GDM) is a major public health issue and a threat to the well-being of a mother and her offspring. As a growing concern in sub-Saharan Africa, this paper explores the knowledge, attitude, and practices of healthy expectant mothers towards GDM, and the content of GDM information delivered by prenatal nurses during Antenatal Clinic (ANC) in Warri, Delta State, Nigeria. Semi-structured telephone interviews were employed with 22 participants comprising 20 pregnant women and 2 antenatal nurses. The results reveal that majority of the pregnant women were unaware of GDM as a particular health condition during pregnancy that poses a risk to both maternal and infant health and could lead to a long-term risk of developing the chronic condition of Type 2 Diabetes Mellitus (T2DM). This low level of awareness was attributed to a lack of adequate information during prenatal clinic sessions. The findings from this study emphasize the need to enhance the quality of public health education offered to pregnant women during pre and antenatal clinical services emphasizing GDM as part of the overall global agenda on promoting maternal and infant health.
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Cho GJ, Kim HY, Ko HS, Cho HJ, Hong SY, Noh E, Jeong YJ. Pregnancy outcomes of immigrant women living in Korea: A population-based study. PLoS One 2022; 17:e0278193. [PMID: 36445896 PMCID: PMC9707740 DOI: 10.1371/journal.pone.0278193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 11/13/2022] [Indexed: 11/30/2022] Open
Abstract
Although there is a high rate of pregnant immigrant women in Korea, little is known regarding their pregnancy outcomes. The aim of this study was to evaluate the pregnancy outcomes of immigrant women in Korea. Data for all pregnant women who gave birth between January 1, 2007 and December 31, 2016 were obtained using the Health Insurance Review and Assessment Service Database. Pregnant women were divided into two groups: Korean and immigrant women. The main outcome measures were adverse pregnancy outcomes including gestational diabetes of mellitus, preeclampsia, cesarean section, placental abrnomalities, and postpartum hemorrhage. The odds of gestational diabetes mellitus, preeclampsia, cesarean section, placental previa, placental abruptio, and postpartum hemorrhage was compared between the two groups. Among 4,439,778 pregnant women who gave birth during the study period, 168,940 (3.8%) were immigrant women. The odds of gestational diabetes mellitus (adjusted OR: 1.24; 95% CI: 1.21, 1.28), and cesarean section (adjusted OR: 1.26; 95% CI: 1.25-1.28)were higher in immigrant women than in Korean women, but the odds of preeclampsia (adjusted OR: 0.84; 95% CI: 0.81-0.86) and postpartum hemorrhage (adjusted OR 0.96, 95% CI 0.94-0.97) was lower in immigrant women than in Korean women. Immigrant women had different pregnancy outcomes. Pregnancy and postpartum management that reflects these characteristics will be necessary for immigrant women.
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Affiliation(s)
- Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ho Yeon Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Sun Ko
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hae Joong Cho
- Department of Obstetrics & Gynecology, College of Medicine, WonKwang University, Iksan, Republic of Korea
| | - Seong Yeon Hong
- Department of Obstetrics and Gynecology, Catholic University of Daegu School of Medicine, Gyeongsan-si, Republic of Korea
| | - Eunjin Noh
- Korean University Guro Hospital Smart Healthcare Center, Seoul, Republic of Korea
| | - Young Ju Jeong
- Department of Obstetrics and Gynecology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
- * E-mail:
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12
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Kragelund Nielsen K, Davidsen E, Husted Henriksen A, Andersen GS. Gestational Diabetes and International Migration. J Endocr Soc 2022; 7:bvac160. [DOI: 10.1210/jendso/bvac160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
In many countries, immigrant women constitute a substantial proportion of women giving birth. With gestational diabetes being one of the most common complications in pregnancy, understanding gestational diabetes in the context of international migration becomes increasingly relevant. Here, we examine the current evidence related to international migration and gestational diabetes, including short- and long-term adverse outcomes and the experiences of immigrant women with gestational diabetes care and long-term follow-up. Existing evidence focuses on immigrants in high-income countries, and has mainly examined differences in the risk of developing gestational diabetes, or on the experiences of immigrant women diagnosed with gestational diabetes. Studies suggest that the risk of gestational diabetes may be influenced by migration and that immigrant women likely experience particular barriers to care and follow-up. Current research on perinatal outcomes is inconclusive and studies on long-term outcomes are practically absent. Future research should include data on country of origin and examine the role of premigration and postmigration factors in developing gestational diabetes and its associated short- and long-term outcomes. Understanding these factors will provide useful insights into improving the health and health care needs of migrating populations and enable inclusion of culturally appropriate health care practices, thereby improving the health of our current and future generations.
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Affiliation(s)
| | - Emma Davidsen
- Health Promotion Research, Steno Diabetes Center Copenhagen , 2730 Herlev , Denmark
| | | | - Gregers S Andersen
- Clinical Research, Steno Diabetes Center Copenhagen , 2730 Herlev , Denmark
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13
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Neven ACH, Lake AJ, Williams A, O'Reilly SL, Hendrieckx C, Morrison M, Dunbar JA, Speight J, Teede H, Boyle JA. Barriers to and enablers of postpartum health behaviours among women from diverse cultural backgrounds with prior gestational diabetes: A systematic review and qualitative synthesis applying the theoretical domains framework. Diabet Med 2022; 39:e14945. [PMID: 36004677 PMCID: PMC9826483 DOI: 10.1111/dme.14945] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/08/2022] [Accepted: 08/18/2022] [Indexed: 01/11/2023]
Abstract
AIMS Racial and ethnic disparities exist in gestational diabetes prevalence and risk of subsequent type 2 diabetes mellitus (T2DM). Postpartum engagement in healthy behaviours is recommended for prevention and early detection of T2DM, yet uptake is low among women from diverse cultural backgrounds. Greater understanding of factors impacting postpartum health behaviours is needed. Applying the Theoretical Domains Framework (TDF) and Capability, Opportunity, Motivation-Behaviour (COM-B) model, our aim was to synthesise barriers to and enablers of postpartum health behaviours among women from diverse cultural backgrounds with prior GDM and identify relevant intervention components. METHODS Databases, reference lists and grey literature were searched from September 2017 to April 2021. Two reviewers screened articles independently against inclusion criteria and extracted data. Using an inductive-deductive model, themes were mapped to the TDF and COM-B model. RESULTS After screening 5148 citations and 139 full texts, we included 35 studies (N = 787 participants). The main ethnicities included Asian (43%), Indigenous (15%) and African (11%). Barriers and enablers focused on Capability (e.g. knowledge), Opportunity (e.g. competing demands, social support from family, friends and healthcare professionals, culturally appropriate education and resources) and Motivation (e.g. negative emotions, perceived consequences and necessity of health behaviours, social/cultural identity). Five relevant intervention functions are identified to link the barriers and enablers to evidence-based recommendations for communications to support behaviour change. CONCLUSIONS We provide a conceptual model to inform recommendations regarding the development of messaging and interventions to support women from diverse cultural backgrounds in engaging in healthy behaviours to reduce risk of T2DM.
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Affiliation(s)
- Adriana C. H. Neven
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive MedicineMonash UniversityClaytonVictoriaAustralia
| | - Amelia J. Lake
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes VictoriaMelbourneVictoriaAustralia
| | - Amelia Williams
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes VictoriaMelbourneVictoriaAustralia
| | - Sharleen L. O'Reilly
- Centre for Physical Activity and Nutrition ResearchDeakin UniversityBurwoodVictoriaAustralia
- UCD Institute of Food and Health, School of Agriculture and Food Science, University CollegeDublin 4Ireland
| | - Christel Hendrieckx
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes VictoriaMelbourneVictoriaAustralia
| | | | - James A. Dunbar
- Deakin Rural Health, School of MedicineDeakin UniversityWarrnamboolVictoriaAustralia
| | - Jane Speight
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes VictoriaMelbourneVictoriaAustralia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive MedicineMonash UniversityClaytonVictoriaAustralia
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Nisar M, Khan A, Kolbe‐Alexander TL. 'Cost, culture and circumstances': Barriers and enablers of health behaviours in South Asian immigrants of Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3138-e3149. [PMID: 35181973 PMCID: PMC9543603 DOI: 10.1111/hsc.13759] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/30/2021] [Accepted: 02/06/2022] [Indexed: 05/10/2023]
Abstract
The health behaviours related to chronic diseases experienced by South Asian immigrants are interrelated with their culture and socioeconomic conditions. South Asian immigrants experience a disproportionate burden of chronic disease compared with non-immigrants Australian-born general population. The primary aim of this study was to gain an in-depth understanding of health behaviours and healthcare access in the South Asian immigrant population of Australia. Five focus group discussions (FGDs) were conducted with South Asian immigrants (n = 29; 18 females) aged 27-50 years in Brisbane, Australia. Separate FGDs were conducted for males and females in the English language. Semi-structured guided questions related to the perception, barriers and facilitators of health behaviours. Data were analysed with Nvivo-12 following a thematic analysis. A conceptual model is proposed to provide a summarised understanding of barriers and facilitators of health behaviours in South Asian immigrants. The major reported constraints for participating in physical activity were cultural beliefs, lack of time, work stress and high fees of fitness activities, while parks and peer modelling were mentioned as a strong motivator for walking, cycling and participating in group sports activities. The cultural and religious connections, cost of cigarettes and drink driving penalties were the most mentioned facilitators for a healthy lifestyle. The important factors related to unhealthy eating habits were the traditional cooking methods, social interactions and the high cost of fruits and vegetables. Community perceptions and language barriers were also acknowledged as the main factors for the decrease in accessing health care services. This study illustrates that cultural beliefs, high cost of healthy food and facilities and social circumstances are mainly linked with the health behaviours and healthcare access in South Asian immigrant's lifestyles.
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Affiliation(s)
- Mehwish Nisar
- School of Health & Rehabilitation SciencesThe University of QueenslandBrisbaneAustralia
| | - Asaduzzaman Khan
- School of Health & Rehabilitation SciencesThe University of QueenslandBrisbaneAustralia
| | - Tracy L. Kolbe‐Alexander
- School of Health & WellbeingUniversity of Southern QueenslandIpswichAustralia
- Division of Exercise Science and Sports MedicineDepartment of Human BiologyFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
- School of Human Movement and Nutrition SciencesThe University of QueenslandBrisbaneAustralia
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15
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A scoping review of gestational diabetes mellitus healthcare: experiences of care reported by pregnant women internationally. BMC Pregnancy Childbirth 2022; 22:627. [PMID: 35941555 PMCID: PMC9361509 DOI: 10.1186/s12884-022-04931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022] Open
Abstract
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.
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Iradukunda F, Harper KM, Paterno MT, Poudel-Tandukar K. Dietary transition among Sub-Saharan Africa women post-immigration and during pregnancy. ETHNICITY & HEALTH 2022; 27:1329-1344. [PMID: 33565334 DOI: 10.1080/13557858.2021.1879027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/17/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Black immigrant women experience high risks for maternal complications, and some of these complications are related to dietary outcomes. This study aimed to explore Sub-Saharan African (SSA) pregnant women's dietary patterns and dietary transition post-immigration and during pregnancy. METHODS We used a narrative design with a Photovoice approach and collected data through semi-structured interviews, digital food diaries, and Photovoice interviews. We recruited eleven participants (n = 11) through community gatekeepers and analyzed data using a constructivist grounded theory approach with constant comparative methods. RESULTS The changes in food processes and participants' reactions to these changes generated a dietary transition model with three stages: perplexity, deliberation, and acceptance. (1) Perplexity was caused by different food characteristics such as taste, texture, and options. (2) Participants described deliberation as a process of deciding the kind of foods/cooking styles that would be an integral part of their regular diet. All participants opted for what they referred to as the 'African diet.' (3) Acceptance was characterized by participants' resolve to figure out how to make their chosen types of food and eating habits 'work' for themselves and their families. CONCLUSION This study emphasizes the importance of having a sense of self-efficacy, a positive attitude, and community support in enabling migrant women to navigate dietary transition until they are satisfied with newly constructed eating habits. This determination, along with community support and persistent connection to their home culture, might help immigrants resist dietary acculturation and maintain healthy cultural eating habits, which is particularly important during pregnancy, given the impact of diet on maternal and neonatal outcomes. These findings underscore the need for collaborating with migrants from SSA to develop culturally tailored dietary interventions focused on each stage of dietary transition. Future studies should include focus group discussions to leverage women's shared experiences and create knowledge/information exchange opportunities.
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Affiliation(s)
| | - Krista M Harper
- Department of Anthropology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Mary T Paterno
- College of Nursing, University of Massachusetts Amherst, Amherst, MA, USA
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17
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Smith R, Michalopoulou M, Reid H, Riches SP, Wango YN, Kenworthy Y, Roman C, Santos M, Hirst JE, Mackillop L. Applying the behaviour change wheel to develop a smartphone application 'stay-active' to increase physical activity in women with gestational diabetes. BMC Pregnancy Childbirth 2022; 22:253. [PMID: 35346075 PMCID: PMC8962081 DOI: 10.1186/s12884-022-04539-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/14/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Physical activity (PA) interventions are an important but underutilised component in the management of gestational diabetes mellitus (GDM). The challenge remains how to deliver cost effective PA interventions that have impact on individual behaviour. Digital technologies can support and promote PA remotely at scale. We describe the development of a behaviourally informed smartphone application (Stay-Active) for women attending an NHS GDM clinic. Stay-Active will support an existing motivational interviewing intervention to increase and maintain PA in this population. METHODS The behaviour change wheel (BCW) eight step theoretical approach was used to design the application. It provided a systematic approach to understanding the target behaviour, identifying relevant intervention functions, and specifying intervention content. The target behaviour was to increase and maintain PA. To obtain a behavioural diagnosis, qualitative evidence was combined with focus groups on the barriers and facilitators to PA in women with GDM. The findings were mapped onto the Capability Opportunity Motivation-Behaviour (COM-B) model and Theoretical Domains Framework to identify what needs to change for the target behaviour and linked to appropriate intervention functions. Finally, behaviour changes techniques (BCT) and modes of delivery that are most likely to serve the intervention functions were selected. Current evidence, patient focus groups and input from key stakeholders informed Stay-Active's development. RESULTS We found that psychological capability, reflective and automatic motivation, social and physical opportunity needed to change to increase PA in women with GDM. The four key intervention functions identified were Enablement, Education, Persuasion and Training. Stay-Active incorporates these four intervention functions delivering ten BCTs including: goal setting, credible source, self-monitoring, action planning, prompts and cues. The final design of Stay-Active delivers these BCTs via an educational resource centre, with goal setting and action planning features, personalised performance feedback and individualised promotional messages. CONCLUSION The BCW has enabled the systematic and comprehensive development of Stay-Active to promote PA in women with GDM within an NHS Maternity service. The next phase is to conduct a trial to assess the feasibility and acceptability of a multi-component intervention that combines Stay-Active with PA Motivational Interviewing.
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Affiliation(s)
- R Smith
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Oxford, OX3 7LD, UK.
| | - M Michalopoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - H Reid
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Oxford, OX3 7LD, UK
| | - S Payne Riches
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Y N Wango
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Y Kenworthy
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - C Roman
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England
| | - M Santos
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England
| | - J E Hirst
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, England
| | - L Mackillop
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, England
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18
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Kytö M, Koivusalo S, Ruonala A, Strömberg L, Tuomonen H, Heinonen S, Jacucci G. Behavior Change Apps for Gestational Diabetes Management: Design and evaluation of desirable features (Preprint). JMIR Hum Factors 2022; 9:e36987. [PMID: 36222806 PMCID: PMC9607927 DOI: 10.2196/36987] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 09/09/2022] [Accepted: 09/10/2022] [Indexed: 01/16/2023] Open
Abstract
Background Gestational diabetes (GDM) has considerable and increasing health effects as it raises both the mother’s and the offspring’s risk for short- and long-term health problems. GDM can usually be treated with a healthier lifestyle, such as appropriate dietary modifications and sufficient physical activity. Although telemedicine interventions providing weekly or more frequent feedback from health care professionals have shown the potential to improve glycemic control among women with GDM, apps without extensive input from health care professionals are limited and have not been shown to be effective. Different features in personalization and support have been proposed to increase the efficacy of GDM apps, but the knowledge of how these features should be designed is lacking. Objective The aim of this study is to investigate how GDM apps should be designed, considering the desirable features based on the previous literature. Methods We designed an interactive GDM prototype app that provided example implementations of desirable features, such as providing automatic and personalized suggestions and social support through the app. Women with GDM explored the prototype and provided feedback in semistructured interviews. Results We identified that (1) self-tracking data in GDM apps should be extended with written feedback, (2) habits and goals should be highly customizable to be useful, (3) the app should have different functions to provide social support, and (4) health care professionals should be notified through the app if something unusual occurs. In addition, we found 2 additional themes. First, basic functionalities that are fast to learn by women with GDM who have recently received the diagnosis should be provided, but there should also be deeper features to maintain interest for women with GDM at a later stage of pregnancy. Second, as women with GDM may have feelings of guilt, the app should have a tolerance for and a supporting approach to unfavorable behavior. Conclusions The feedback on the GDM prototype app supported the need for desirable features and provided new insights into how these features should be incorporated into GDM apps. We expect that following the proposed designs and feedback will increase the efficacy of GDM self-management apps. Trial Registration ClinicalTrials.gov NCT03941652; https://clinicaltrials.gov/ct2/show/NCT03941652
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Affiliation(s)
- Mikko Kytö
- Helsinki University Hospital IT Management, Helsinki University Hospital, Helsinki, Finland
- Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - Saila Koivusalo
- Department of Gynecology and Obstetrics, Turku University Hospital, Turku, Finland
- Department of Gynecology and Obstetrics, University of Turku, Turku, Finland
- Department of Gynecology and Obstetrics, Helsinki University Hospital, Helsinki, Finland
- Department of Gynecology and Obstetrics, University of Helsinki, Helsinki, Finland
| | - Antti Ruonala
- Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - Lisbeth Strömberg
- Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - Heli Tuomonen
- Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - Seppo Heinonen
- Department of Gynecology and Obstetrics, Turku University Hospital, Turku, Finland
- Department of Gynecology and Obstetrics, University of Turku, Turku, Finland
| | - Giulio Jacucci
- Department of Computer Science, University of Helsinki, Helsinki, Finland
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Lawrence RL, Ward K, Wall CR, Bloomfield FH. New Zealand women's experiences of managing gestational diabetes through diet: a qualitative study. BMC Pregnancy Childbirth 2021; 21:819. [PMID: 34886814 PMCID: PMC8662890 DOI: 10.1186/s12884-021-04297-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/23/2021] [Indexed: 12/25/2022] Open
Abstract
Background For women with gestational diabetes mellitus (GDM) poor dietary choices can have deleterious consequences for both themselves and their baby. Diet is a well-recognised primary strategy for the management of GDM. Women who develop GDM may receive dietary recommendations from a range of sources that may be inconsistent and are often faced with needing to make several dietary adaptations in a short period of time to achieve glycaemic control. The aim of this study was to explore how women diagnosed with GDM perceive dietary recommendations and how this information influences their dietary decisions during pregnancy and beyond. Methods Women diagnosed with GDM before 30 weeks’ gestation were purposively recruited from two GDM clinics in Auckland, New Zealand. Data were generated using semi-structured interviews and thematic analysed to identify themes describing women’s perceptions and experiences of dietary recommendations for the management of GDM. Results Eighteen women from a diverse range of sociodemographic backgrounds participated in the study. Three interconnected themes described women’s perceptions of dietary recommendations and experiences in managing their GDM through diet: managing GDM is a balancing act; using the numbers as evidence, and the GDM timeframe. The primary objective of dietary advice was perceived to be to control blood glucose levels and this was central to each theme. Women faced a number of challenges in adhering to dietary recommendations. Their relationships with healthcare professionals played a significant role in their perception of advice and motivation to adhere to recommendations. Many women perceived the need to follow dietary recommendations to be temporary, with few planning to continue dietary adaptations long-term. Conclusions The value of empathetic, individually tailored advice was highlighted in this study. A greater emphasis on establishing healthy dietary habits not just during pregnancy but for the long-term health of both mother and baby is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04297-0.
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Affiliation(s)
- R L Lawrence
- The Liggins Institute, The University of Auckland, Building 505, Level 2, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - K Ward
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - C R Wall
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - F H Bloomfield
- The Liggins Institute, The University of Auckland, Building 505, Level 2, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
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Sharma A, Birkeland KI, Nermoen I, Qvigstad E, Tran AT, Gulseth HL, Sollid ST, Wium C, Varsi C. Understanding mechanisms behind unwanted health behaviours in Nordic and South Asian women and how they affect their gestational diabetes follow-ups: A qualitative study. Diabet Med 2021; 38:e14651. [PMID: 34268812 DOI: 10.1111/dme.14651] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/16/2021] [Accepted: 07/13/2021] [Indexed: 12/31/2022]
Abstract
AIMS The type 2 diabetes risk following gestational diabetes mellitus (GDM) is high, particularly among South Asian women in Western countries. Our study aimed to advance the knowledge regarding the mechanisms behind suboptimal follow-up in the Nordic and South Asian women with previous GDM by comparing (1) their experiences, (2) health and disease perceptions and (3) barriers to and facilitators of health-promoting behaviours. METHODS This qualitative study was conducted in three hospital outpatient clinics in Norway, comprising six focus group interviews with 28 women 1-3 years after a pregnancy with GDM. The participants were purposively sampled and grouped according to their ethnicity. The data were analysed using thematic analysis, and a theoretical approach was applied to support the analysis and discuss the study's findings. RESULTS Five main themes were identified: lack of resilience, emotional distress, 'caught between a rock and a hard place', postpartum abandonment and insufficient guidance. The key determinants of the maintenance of unwanted health behaviours after GDM were consistent across the ethnic groups. Although the importance of a culturally sensitive approach was emphasised, it appeared secondary to the need for a more organised public healthcare during and after GDM. CONCLUSIONS Women's real-life constraints, combined with the inadequate healthcare-service implementation, could explain the non-adherence to the lifestyle-changes guidelines essential for preventing diabetes post-GDM. We suggest promoting specific coping strategies and changing the healthcare service approach rather than relying on women's capacity to initiate the necessary changes.
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Affiliation(s)
- Archana Sharma
- Department of Endocrinology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kåre I Birkeland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Ingrid Nermoen
- Department of Endocrinology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elisabeth Qvigstad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Anh T Tran
- Institute of Health and Society, Department of General Practice, University of Oslo, Oslo, Norway
| | | | - Stina T Sollid
- Department of Medicine, Drammen Hospital, Vestre Viken Health Trust, Drammen, Norway
| | | | - Cecilie Varsi
- Department of Digital Health Research, Oslo University Hospital, Oslo, Norway
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Bagger S, Maindal HT, Nielsen KK, Vrå AG, Aagaard-Hansen J. Perceptions of risk and motivation for healthy living among immigrants from non-western countries with prior gestational diabetes mellitus living in Denmark. Health Psychol Behav Med 2021; 9:761-777. [PMID: 34484976 PMCID: PMC8409963 DOI: 10.1080/21642850.2021.1969235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To explore perceptions of risk and motivation for healthy living among immigrant women from non-western countries with prior gestational diabetes mellitus (GDM) living in Denmark. Design Seventeen semi-structured interviews were conducted with 12 female immigrants with prior GDM from non-western countries living in Denmark. The women were recruited through a public hospital and other health services and nongovernmental organisations. The theoretical approach was inspired by Arthur Kleinman’s Explanatory Models. Data were analysed using qualitative content analysis. Results A diagnosis of GDM entailed great worry for the future. Participants’ fears were primarily linked to the potential later development of type 2 diabetes (T2D) and poor health. Women’s perceptions of GDM reflected their experiences with T2D-related complications and even death among relatives. The risk perception of GDM was also influenced by participants’ challenges and trauma unrelated to diabetes. Their motivation for healthy living was strengthened by their experiences with T2D among relatives, while unrelated challenges and trauma generally reduced their capacity for healthier behaviours. Conclusion Among women with a non-western immigrant background and prior GDM living in Denmark, experiences with T2D among family members and their close communities affect their perceptions of risk and motivation to prevent the development of T2D. Furthermore, the challenges of daily life and past trauma were critical factors in their levels of available resources for health. Health promotion in this population should address health in a holistic way by integrating mental and social health with interventions aimed at preventing the development of T2D.
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Affiliation(s)
- Stine Bagger
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Helle Terkildsen Maindal
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Public Health, Section for Health Promotion, Aarhus University, Aarhus, Denmark
| | | | | | - Jens Aagaard-Hansen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Faculty of Health Sciences, SA MRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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22
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Desai D, Kandasamy S, Limbachia J, Zulyniak MA, Ritvo P, Sherifali D, Wahi G, Anand SS, de Souza RJ. Studies to Improve Perinatal Health through Diet and Lifestyle among South Asian Women Living in Canada: A Brief History and Future Research Directions. Nutrients 2021; 13:nu13092932. [PMID: 34578810 PMCID: PMC8465246 DOI: 10.3390/nu13092932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 12/29/2022] Open
Abstract
South Asians (i.e., people who originate from India, Pakistan, Sri Lanka, Nepal, and Bangladesh) have higher cardiovascular disease rates than other populations, and these differences persist in their offspring. Nutrition is a critical lifestyle-related factor that influences fetal development, and infant and child health in early life. In high-income countries such as Canada, nutrition-related health risks arise primarily from overnutrition, most strikingly for obesity and associated non-communicable diseases. Evidence for developmental programming during fetal life underscores the critical influence of maternal diet on fetal growth and development, backed by several birth cohort studies including the Pune Maternal Nutrition Study, the South Asian Birth Cohort Study, and the Born in Bradford Study. Gestational diabetes mellitus is a strong risk factor for type 2 diabetes, future atherosclerosis and cardiovascular disease in the mother and increases the risk of type 2 diabetes in her offspring. Non-pharmacological trials to prevent gestational diabetes are few, often not randomized, and are heterogeneous with respect to design, and outcomes have not converged upon a single optimal prevention strategy. The aim of this review is to provide an understanding of the current knowledge around perinatal nutrition and gestational diabetes among the high-risk South Asian population as well as summarize our research activities investigating the role of culturally-tailored nutrition advice to South Asian women living in high-income settings such as Canada. In this paper, we describe these qualitative and quantitative studies, both completed and underway. We conclude with a description of the design of a randomized trial of a culturally tailored personalized nutrition intervention to reduce gestational glycaemia in South Asian women living in Canada and its implications.
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Affiliation(s)
- Dipika Desai
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON L8L 2X2, Canada; (D.D.); (D.S.); (S.S.A.)
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.K.); (G.W.)
| | - Sujane Kandasamy
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.K.); (G.W.)
| | - Jayneel Limbachia
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Michael A. Zulyniak
- School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK;
| | - Paul Ritvo
- Department of Psychology, York University, North York, ON M3J 1P3, Canada;
| | - Diana Sherifali
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON L8L 2X2, Canada; (D.D.); (D.S.); (S.S.A.)
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.K.); (G.W.)
- School of Nursing, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Gita Wahi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.K.); (G.W.)
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Sonia S. Anand
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON L8L 2X2, Canada; (D.D.); (D.S.); (S.S.A.)
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.K.); (G.W.)
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Russell J. de Souza
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON L8L 2X2, Canada; (D.D.); (D.S.); (S.S.A.)
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.K.); (G.W.)
- Correspondence:
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A Longitudinal Assessment of Risk Factors and Chronic Diseases among Immigrant and Non-Immigrant Adults in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168621. [PMID: 34444370 PMCID: PMC8392710 DOI: 10.3390/ijerph18168621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022]
Abstract
This study aimed to investigate the prevalence and trajectories of chronic diseases and risk behaviors in immigrants from high-income countries (HIC), low–middle-income countries (LMIC), to Australian-born people. Data were used from five waves of the HABITAT (2007–2016) study—11,035 adults living in Brisbane, Australia. Chronic diseases included cancer, diabetes mellitus, coronary heart disease, and chronic obstructive pulmonary disease (COPD). Risk factors assessed were body mass index (BMI), insufficient physical activity, and cigarette smoking. Diabetes mellitus increased in all groups, with the highest increase of 33% in LMIC immigrants. The prevalence of cancers increased 19.6% in the Australian-born, 16.6% in HIC immigrants, and 5.1% in LMIC immigrants. The prevalence of asthma increased in HIC immigrants while decreased in the other two groups. Poisson regression showed that LMIC immigrants had 1.12 times higher rates of insufficient physical activity, 0.75 times lower rates of smoking, and 0.77 times lower rates of being overweight than the Australian-born population. HIC immigrants had 0.96 times lower rates of insufficient physical activity and 0.93 times lower rates of overweight than Australian-born. The findings of this study can inform better strategies to reduce health disparities by targeting high-risk cohorts.
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Delanerolle G, Phiri P, Zeng Y, Marston K, Tempest N, Busuulwa P, Shetty A, Goodison W, Muniraman H, Duffy G, Elliot K, Maclean A, Majumder K, Hirsch M, Rathod S, Raymont V, Shi JQ, Hapangama DK. A systematic review and meta-analysis of gestational diabetes mellitus and mental health among BAME populations. EClinicalMedicine 2021; 38:101016. [PMID: 34308317 PMCID: PMC8283332 DOI: 10.1016/j.eclinm.2021.101016] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/02/2021] [Accepted: 06/21/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a common complication of pregnancy and is associated with an increased risk of mental health (MH) disorders including antenatal and postnatal depression (PND), anxiety and post-traumatic-stress-disorder (PTSD). We hypothesized GDM and MH disorders will disproportionately affect individuals from Black, Asian and Minority Ethnic backgrounds. METHODS A systematic methodology was developed, and a protocol was published in PROSPERO (CRD42020210863) and a systematic review of publications between 1st January 1990 and 30th January 2021 was conducted. Multiple electronic databases were explored using keywords and MeSH terms. The finalised dataset was analysed using statistical methods such as random-effect models, subgroup analysis and sensitivity analysis. These were used to determine odds ratio (OR) and 95% confidence intervals (CI) to establish prevalence using variables of PND, anxiety, PTSD and stress to name a few. FINDINGS Sixty studies were finalised from the 20,040 data pool. Forty-six studies were included systematically with 14 used to meta-analyze GDM and MH outcomes. A second meta-analysis was conducted using 7 studies to determine GDM risk among Black, Asian and Minority Ethnic women with pre-existing MH disorders. The results indicate an increased risk with pooled adjusted OR for both reflected at 1.23, 95% CI of 1.00-1.50 and 1.29, 95% CI of 1.11-1.50 respectively. INTERPRETATION The available studies suggest a MH sequalae with GDM as well as a sequalae of GDM with MH among Black, Asian and Minority Ethnic populations. Our findings warrant further future exploration to better manage these patients. FUNDING Not applicable.
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Affiliation(s)
| | - Peter Phiri
- Southern Health NHS Foundation Trust, United Kingdom
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, United Kingdom
| | - Yutian Zeng
- Southern University of Science and Technology, United Kingdom
| | | | - Nicola Tempest
- University of Liverpool, United Kingdom
- Liverpool Women's Hospital NHS Foundation Trust, United Kingdom
| | - Paula Busuulwa
- University of Liverpool, United Kingdom
- Liverpool Women's Hospital NHS Foundation Trust, United Kingdom
| | - Ashish Shetty
- University College London Hospitals NHS Foundation Trust, United Kingdom
- University College London, United Kingdom
| | - William Goodison
- University College London Hospitals NHS Foundation Trust, United Kingdom
| | - Hemananda Muniraman
- Department of Pediatrics, Creighton University Medical School, United Kingdom
| | | | | | - Alison Maclean
- University of Liverpool, United Kingdom
- Liverpool Women's Hospital NHS Foundation Trust, United Kingdom
| | | | - Martin Hirsch
- University College London Hospitals NHS Foundation Trust, United Kingdom
| | | | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, United Kingdom
| | - Jian Qing Shi
- Southern University of Science and Technology, United Kingdom
- Alan Turing Institute, United Kingdom
| | - Dharani K. Hapangama
- University of Liverpool, United Kingdom
- Liverpool Women's Hospital NHS Foundation Trust, United Kingdom
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Bandyopadhyay M. Gestational diabetes mellitus: a qualitative study of lived experiences of South Asian immigrant women and perspectives of their health care providers in Melbourne, Australia. BMC Pregnancy Childbirth 2021; 21:500. [PMID: 34243754 PMCID: PMC8272384 DOI: 10.1186/s12884-021-03981-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 06/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Asian women are at a high risk of developing gestational diabetes mellitus than other women in Australia. Gestational diabetes affects up to 14-19% of all pregnancies among South Asian, South East Asian, and Arabic populations placing women at risk of adverse pregnancy outcomes. Although, gestational diabetes resolves after childbirth, women with gestational diabetes are up to seven times more likely to develop type 2 diabetes within five to ten years of the index pregnancy. Increasingly, South Asian women are being diagnosed with gestational diabetes in Australia. Therefore, we aimed to gain a better understanding of the lived experiences of South Asian women and their experiences of self-management and their health care providers' perspectives of treatment strategies. METHODS Using an ethnographic qualitative research methodology, semi-structured one-on-one, face-to-face interviews were conducted with 21 health care providers involved in gestational diabetes management and treatment from the three largest tertiary level maternity hospitals in Melbourne, Victoria, Australia. In-depth interviews were conducted with 23 South Asian women post diagnosis between 24-28 weeks gestation in pregnancy. RESULTS Health care providers had challenges in providing care to South Asian women. The main challenge was to get women to self-manage their blood glucose levels with lifestyle modification. Whilst, women felt self-management information provided were inadequate and inappropriate to their needs. Women felt 'losing control over their pregnancy', because of being preoccupied with diet and exercise to control their blood glucose level. CONCLUSIONS The gestational diabetes clinical practice at the study hospitals were unable to meet consumer expectations. Health care providers need to be familiar of diverse patient cultures, rather than applying the current 'one size fits all' approach that failed to engage and meet the needs of immigrant and ethnic women. Future enabling strategies should aim to co-design and develop low Glycaemic Index diet plans of staple South Asian foods and lifestyle modification messages.
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Affiliation(s)
- Mridula Bandyopadhyay
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville Victoria, 3052, Australia.
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Croxford S, Gupta D, Bandyopadhyay M, Itsiopoulos C. An evaluation of dietary intakes of a selected group of South Asian migrant women with gestational diabetes mellitus. ETHNICITY & HEALTH 2021; 26:487-503. [PMID: 30360630 DOI: 10.1080/13557858.2018.1539217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 10/11/2018] [Indexed: 06/08/2023]
Abstract
Background: Women of South Asian descent have an increased risk of developing gestational diabetes mellitus (GDM), and type 2 diabetes mellitus compared to Caucasian women. Dietary advice provided by health practitioners to this group has been found to be culturally inappropriate. The aim of this study was to describe the dietary intakes of South Asian women with gestational diabetes and use this information to develop culturally appropriate dietary models for education and support of dietary management.Method: An in-depth diet and lifestyle survey was administered with 13 eligible women. Dietary histories were collected for pre-pregnancy, during pregnancy and post-GDM diagnosis to evaluate changes in dietary intake, diet and health beliefs and traditional foods consumed during pregnancy.Results: The diets of participants did not meet nutrient requirements for pregnancy; specific areas on concern were dietary fibre, calcium, iron, folate and iodine. Vegetarians were particularly at risk with regards to energy and protein intake. Generally dietary intakes of these women with GDM were not consistent with guidelines for management of GDM. Confusion about what they should eat for GDM, health practitioner advice and conflict with cultural expectations about foods to consume during pregnancy was evident.Conclusion: The dietary information collected from these women was used to model sample menus for GDM that were culturally appropriate and consistent with vegetarian and non-vegetarian eating patterns.
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Iradukunda F, Poudel-Tandukar K. Healthy Diet Perceptions of Pregnant Women from Sub-Saharan Africa Residing in the U.S. Ecol Food Nutr 2021; 60:682-696. [PMID: 33467928 DOI: 10.1080/03670244.2021.1875457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Several consumers lack a clear understanding of what makes a healthy diet. This uncertainty may be worsened by immigration due to socio-cultural differences. The purpose of this study was to explore Sub-Saharan African (SSA) pregnant women's perceptions of a healthy diet and the sources of dietary information available to them in the context of immigration. We used narrative interviews and photo-food diaries, followed by photo-elucidated interviews to obtain data. Participants defined and illustrated a healthy diet as having four characteristics: (a) Familiar, (b) balanced, (c) made of fresh and organically grown ingredients, and (d) able to build the consumer's body. Participants indicated that the overwhelming nature of dietary information made it difficult to navigate. Participants trusted dietary recommendations offered by family and peers the most, while those offered by health care providers were reported to be difficult to understand or incorporate due to not being culturally specific. This paper highlights the importance of considering consumers' socio-cultural backgrounds and building partnerships between health care providers and the communities they serve to design culturally relevant dietary education.
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Harrison AL, Taylor NF, Frawley HC, Shields N. A consumer co-created infographic improves short-term knowledge about physical activity and self-efficacy to exercise in women with gestational diabetes mellitus: a randomised trial. J Physiother 2020; 66:243-248. [PMID: 33069606 DOI: 10.1016/j.jphys.2020.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 12/18/2022] Open
Abstract
QUESTION In women with gestational diabetes mellitus, does the addition of a consumer co-created infographic to usual education about gestational diabetes mellitus improve knowledge about physical activity and self-efficacy to exercise? DESIGN A randomised trial with concealed allocation, a blinded assessor and intention-to-treat analysis. PARTICIPANTS Sixty-nine women diagnosed with gestational diabetes mellitus. INTERVENTION In addition to gestational diabetes education, the experimental group received a paper copy of a consumer co-created infographic about physical activity during a gestational diabetes pregnancy. The control group received gestational diabetes education alone. OUTCOME MEASURES Participants completed outcome measures at baseline and again 1 week later. Knowledge of physical activity in a gestational diabetes mellitus pregnancy was assessed using a 19-item questionnaire modified to reflect current physical activity guidelines, with a total score from 0% (worst) to 100% (best). Self-efficacy was measured using the nine-item Self-Efficacy for Exercise Scale, with a total score from 0 (not confident) to 10 (very confident). RESULTS Provision of the infographic led to a clinically important between-group difference in knowledge (MD 12%, 95% CI 10 to 15) and self-efficacy (MD 2.5 units, 95% CI 1.9 to 3.0). CONCLUSION In women with gestational diabetes mellitus, short-term knowledge about physical activity and self-efficacy to exercise were improved when usual education was supplemented with a consumer co-created infographic that provided specific and relevant information about physical activity during a gestational diabetes mellitus pregnancy. TRIAL REGISTRATION ACTRN12619001207101.
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Affiliation(s)
- Anne L Harrison
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Australia; Physiotherapy Department, Werribee Mercy Hospital, Melbourne, Australia.
| | - Nicholas F Taylor
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Australia; Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia
| | - Helena C Frawley
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Nora Shields
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Australia
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Barriers to postpartum follow-up of mothers with gestational diabetes mellitus and its implications: a mixed method study. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00853-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kandasamy S, Nguyen L, Desai D, Anand SS, Sherifali D, de Souza RJ. Barriers to, and Facilitators of, Lifestyle Changes to Prevent Gestational Diabetes: An Interpretive Description of South Asian Women and Health-Care Providers Living and Working in Southern Ontario, Canada. Can J Diabetes 2020; 45:144-154. [PMID: 33039328 DOI: 10.1016/j.jcjd.2020.07.001] [Citation(s) in RCA: 12] [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: 07/17/2019] [Revised: 04/25/2020] [Accepted: 07/02/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES People of South Asian ancestry are the fastest growing non-Caucasian ethnic group in Canada and are at high risk for developing type 2 diabetes and coronary heart disease. Pregnant South Asian women have a 2-fold increased risk of developing gestational diabetes, which increases their risk of type 2 diabetes and coronary heart disease. The specific objectives of this study were to explore the perceptions of health behaviours (diet and physical activity) during pregnancy in the South Asian community. METHODS We used interpretive description to further understand the cultural and contextual factors that influence the knowledge, attitudes and practices of diet and physical activity of South Asian women of childbearing age and those who provide health care to this group. RESULTS Two major themes that emerged from the perspectives of 10 South Asian pregnant women included: (1) importance of considering an individual's locus of control; and (2) support (emotional and information exchange) from family, friends and health-care providers. Two major themes identified by the 11 health-care providers were: (1) cultural awareness in caring for South Asian women during pregnancy; and (2) clinic management, logistics and resources. A common theme for both South Asian pregnant women and health-care providers was the importance of considering the cultural landscape in relation to how knowledge is obtained, shared and valued. CONCLUSION A better understanding of these cultural underpinnings may support the development of interventions tailored for pregnant South Asian women and their health-care providers.
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Affiliation(s)
- Sujane Kandasamy
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Linda Nguyen
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Dipika Desai
- Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | - Sonia S Anand
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Diana Sherifali
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada.
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Subasinghe AK, Nankervis AJ, Boyle JA, Mazza D. Optimising the implementation of guidelines for the post partum testing and management of gestational diabetes in South Asian women in Australia. Med J Aust 2020; 213:189-189.e1. [PMID: 32524603 DOI: 10.5694/mja2.50660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
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Barriers and facilitating factors in the prevention of diabetes type 2 and gestational diabetes in vulnerable groups: A scoping review. PLoS One 2020; 15:e0232250. [PMID: 32401778 PMCID: PMC7219729 DOI: 10.1371/journal.pone.0232250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/12/2020] [Indexed: 11/27/2022] Open
Abstract
Aims Type 2 diabetes mellitus (T2DM) and gestational diabetes (GDM) are globally on the rise, accompanied by comorbidities and associated health costs. Increased physical activity, healthy nutrition, and weight loss have shown the potential to prevent T2DM/GDM. Despite this, reaching vulnerable groups remains a key challenge. The aim of this scoping review was to identify barriers and facilitating factors in the prevention of T2DM/GDM in vulnerable groups. Methods We conducted a systematic literature search in May 2018, updated in September 2019, in several databases (e.g. PubMed, Embase) to identify barriers and facilitating factors in the prevention of T2DM/GDM in vulnerable groups. Two reviewers independently screened the results. Extracted data was charted, categorized, and summarized. Results We included 125 articles. Ninety-eight studies were extracted, and eight categories of barriers and facilitating factors were formed. The most common categories of barriers were limited knowledge, family/friends, and economic factors, and the most common categories of facilitating factors were family/friends, social support, and knowledge. Conclusion This scoping review identified various barriers and facilitating factors in vulnerable groups. Preventive interventions should consider these barriers and facilitating factors in developing preventive interventions or in adapting existing ones.
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"If I Don't Eat Enough, I Won't Be Healthy". Women's Experiences with Gestational Diabetes Mellitus Treatment in Rural and Urban South India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093062. [PMID: 32354048 PMCID: PMC7246422 DOI: 10.3390/ijerph17093062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/10/2020] [Accepted: 04/23/2020] [Indexed: 12/12/2022]
Abstract
Gestational diabetes mellitus (GDM) is associated with a range of adverse pregnancy outcomes as well as increased risk of future type 2 diabetes and cardiovascular disease. In India, 10%–35% of pregnant women develop GDM. In this study, we investigated women’s experiences with the dietary and pharmaceutical treatment for GDM in rural and urban Tamil Nadu, India. Semi-structured interviews were conducted with 19 women diagnosed with GDM. Data were analyzed using qualitative content analysis. Three overall aspects were discovered with several sub-aspects characterizing women’s experiences: emotional challenges (fear and apprehension for the baby’ health and struggling to accept a treatment seen as counterintuitive to being safe and healthy), interpersonal challenges (managing treatment in the near social relations and social support, and coordinating treatment with work and social life), and health system-related challenges (availability and cost of treatment, interaction with health care providers). Some aspects acted as barriers. However, social support and positive, high-quality interactions with health care providers could mitigate some of these barriers and facilitate the treatment process. Greater efforts at awareness creation in the social environment and systemic adjustments in care delivery targeting the individual, family, community and health system levels are needed in order to ensure that women with GDM have the opportunity to access treatment and are enabled and motivated to follow it as well.
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Craig L, Sims R, Glasziou P, Thomas R. Women's experiences of a diagnosis of gestational diabetes mellitus: a systematic review. BMC Pregnancy Childbirth 2020; 20:76. [PMID: 32028931 PMCID: PMC7006162 DOI: 10.1186/s12884-020-2745-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/15/2020] [Indexed: 12/17/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) - a transitory form of diabetes induced by pregnancy - has potentially important short and long-term health consequences for both the mother and her baby. There is no globally agreed definition of GDM, but definition changes have increased the incidence in some countries in recent years, with some research suggesting minimal clinical improvement in outcomes. The aim of this qualitative systematic review was to identify the psychosocial experiences a diagnosis of GDM has on women during pregnancy and the postpartum period. Methods We searched CINAHL, EMBASE, MEDLINE and PsycINFO databases for studies that provided qualitative data on the psychosocial experiences of a diagnosis of GDM on women across any stage of pregnancy and/or the postpartum period. We appraised the methodological quality of the included studies using the Critical Appraisal Skills Programme Checklist for Qualitative Studies and used thematic analysis to synthesis the data. Results Of 840 studies identified, 41 studies of diverse populations met the selection criteria. The synthesis revealed eight key themes: initial psychological impact; communicating the diagnosis; knowledge of GDM; risk perception; management of GDM; burden of GDM; social support; and gaining control. The identified benefits of a GDM diagnosis were largely behavioural and included an opportunity to make healthy eating changes. The identified harms were emotional, financial and cultural. Women commented about the added responsibility (eating regimens, appointments), financial constraints (expensive food, medical bills) and conflicts with their cultural practices (alternative eating, lack of information about traditional food). Some women reported living in fear of risking the health of their baby and conducted extreme behaviours such as purging and starving themselves. Conclusion A diagnosis of GDM has wide reaching consequences that are common to a diverse group of women. Threshold cut-offs for blood glucose levels have been determined using the risk of physiological harms to mother and baby. It may also be advantageous to consider the harms and benefits from a psychosocial and a physiological perspective. This may avoid unnecessary burden to an already vulnerable population.
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Affiliation(s)
- Louise Craig
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Rebecca Sims
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia.
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de Sequeira S, Halperin I, Lipscombe LL. Culturally Tailored Resources for South Asian Immigrant Women With Gestational Diabetes: Do They Work and What's Missing? A Qualitative Study. Can J Diabetes 2019; 43:573-579. [PMID: 31787243 DOI: 10.1016/j.jcjd.2019.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/06/2019] [Accepted: 09/23/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Gestational diabetes mellitus (GDM) increases the risk of pregnancy complications. South Asian immigrant women have among the highest rates of GDM in Canada and they also have the highest lifelong risk of developing type 2 diabetes after a GDM pregnancy. Diabetes Canada has been developing diabetes education material that accounts for the cultural preferences of South Asians. However, there is uncertainty to whether South Asian immigrants are aware of these resources or trust them, or if other factors influence their uptake of advice. METHODS In this study, we conducted qualitative interviews to explore, among South Asian immigrant women with GDM: 1) their awareness of diabetes education resources, 2) their attitudes toward information from different resources and varying health-care providers and 3) their barriers and facilitators for GDM management recommendations. Gender theory is embedded in this study, as culturally specific gender roles regarding motherhood have been shown to be important to South Asian immigrant women and their perceptions of health. RESULTS There was an emergence of 3 main themes. First, awareness of culturally tailored educational resources is low. Second, there is an overabundance of GDM management information, which leads to variability among participants of how they rank accuracy of informational sources. Finally, there is a gender role reversal present, where women are being taken care of by their families instead of being the providers of care. CONCLUSIONS These results indicate that better dissemination strategies for GDM educational material are needed for health-care providers and patients, and may require additional consideration of family involvement during GDM education sessions.
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Affiliation(s)
- Stephanie de Sequeira
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Ilana Halperin
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lorraine L Lipscombe
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Dennison RA, Ward RJ, Griffin SJ, Usher‐Smith JA. Women's views on lifestyle changes to reduce the risk of developing Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for practice. Diabet Med 2019; 36:702-717. [PMID: 30723968 PMCID: PMC6563496 DOI: 10.1111/dme.13926] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 12/16/2022]
Abstract
AIMS After gestational diabetes, many women exhibit behaviours that increase their risk of developing Type 2 diabetes. We aimed to systematically synthesize the literature that focuses on the views of women with a history of gestational diabetes on reducing their risk of developing diabetes postpartum through lifestyle and behaviour changes. METHODS We identified qualitative studies that examined the views of women with a history of gestational diabetes towards healthy eating and physical activity, Type 2 diabetes risk management or their experience of a diabetes prevention programme, and conducted a thematic synthesis to develop descriptive and then analytical themes. We also evaluated the quality of each study and the confidence that we had in our findings. RESULTS We included 21 articles after screening 23 160 citations and 129 full texts. We identified six themes of interacting influences on postpartum behaviour: role as mother and priorities; social support; demands of life; personal preferences and experiences; risk perception and information; and finances and resources (plus preferred format of interventions). These factors inhibited many women from addressing their own health, while they motivated others to persevere. We also developed 20 recommendations, most with high or moderate confidence, for effective promotion of healthy lifestyles in this population. CONCLUSIONS Many factors hinder healthy lifestyles after gestational diabetes, yet how women interpret them can motivate or prevent changes that reduce diabetes risk. As our recommendations emphasize, women's experiences and needs should be considered when designing strategies to promote healthier lifestyles in this population.
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Affiliation(s)
- R. A. Dennison
- Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - R. J. Ward
- Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - S. J. Griffin
- Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - J. A. Usher‐Smith
- Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
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Exploring the effectiveness of physical activity interventions in women with previous gestational diabetes: A systematic review of quantitative and qualitative studies. Prev Med Rep 2019; 14:100877. [PMID: 31110933 PMCID: PMC6510702 DOI: 10.1016/j.pmedr.2019.100877] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/28/2019] [Accepted: 04/22/2019] [Indexed: 12/17/2022] Open
Abstract
Women with previous Gestational Diabetes Mellitus (GDM) have seven times the risk of Type 2 diabetes later in life compared to women without GDM. Physical activity can reduce this risk and most women with previous GDM are not physically active. Aims To explore: (1) effectiveness of physical activity interventions for women with previous GDM; (2) factors that women with previous GDM perceive influence their physical activity; (3) how these factors are addressed by the interventions. Methods A systematic review of quantitative (aim 1) and qualitative (aim 2) studies with a mixed-methods synthesis (aim 3) was conducted in October 2017 following Cochrane methodology. Of 8101 articles identified, twenty-eight studies were included in total: 18 in Review 1 and 10 in Review 2. Results Four interventions significantly increased physical activity and 14 had either mixed effectiveness or no changes in physical activity. Reporting of intervention components and study quality varied greatly. Relevant qualitative factors included accounting for childcare issues, social support and cultural sensitivities. Interventions that incorporated these factors were associated with effectiveness. Education about how to reduce future risk of Type 2 diabetes and using pedometers in interventions were not associated with intervention effectiveness. Other factors that future interventions should address consist of ‘putting others before yourself’; ‘putting off lifestyle change’; ‘lack of support from healthcare professionals’ and ‘being a healthy role model for families’. Conclusion Combining the results of qualitative and quantitative studies can provide a nuanced understanding of the effectiveness of physical activity and lifestyle interventions. Women with previous gestational diabetes are at high risk for type 2 diabetes. Interventions to increase physical activity have not worked for this group. Mixed-methods reviews allow us to identify effective intervention components. Childcare, social support and cultural relevance are part of successful interventions. Interventions should incorporate this review's results to improve effectiveness.
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Jirojwong S, Brownhill S, Dahlen HG, Johnson M, Schmied V. Going up, going down: the experience, control and management of gestational diabetes mellitus among Southeast Asian migrant women living in urban Australia. Health Promot J Austr 2019; 28:123-131. [PMID: 27745571 DOI: 10.1071/he15130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 08/04/2016] [Indexed: 01/15/2023] Open
Abstract
Issue addressed In many developed countries the rate of gestational diabetes mellitus (GDM) for Asian-born women is higher than other groups. Studies suggest that some women have limited knowledge of the disease and poor self-management leading to health problems for themselves and their baby. Few studies report the experience of GDM among Southeast Asian migrant women living in Australia and factors that influence their management of the disease. Methods A qualitative interpretive design was used to explore Southeast Asian migrant women's experience and management of GDM. Women diagnosed with the disease during pregnancy were recruited from an antenatal clinic at two Sydney metropolitan hospitals. Nineteen women were interviewed in their first language. Thematic analysis was used to analyse the data. Results A diagnosis of GDM conferred an unanticipated 'up and down' experience for this group of Southeast Asian women. Their experience of the disease, likened to an elevator ride, was modulated by 'insulin' and 'information' used to control the disease and manage blood glucose levels, dietary levels, exercise levels and anxiety levels. Conclusions Health promotion material that captures the fluctuating experience of GDM has the potential to help women, particularly at the time of diagnosis, to be better prepared, and health professionals to be better informed to control and manage the disease more effectively. So what? GDM is a serious problem. The model generated from our study has the potential to better inform health professionals to prepare women for the inevitable fluctuating physical and emotional effects of the disease. Culturally sensitive material and an educational strategy based on the model may also facilitate women's lifestyle changes and compliance, and improve migrant women's relationship with, and trust in, health professionals involved in their GDM care.
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Affiliation(s)
- Sansnee Jirojwong
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Suzanne Brownhill
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, PO Box 968, North Sydney, NSW 2059, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
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Harrison AL, Taylor NF, Frawley HC, Shields N. Women with gestational diabetes mellitus want clear and practical messages from credible sources about physical activity during pregnancy: a qualitative study. J Physiother 2019; 65:37-42. [PMID: 30573442 DOI: 10.1016/j.jphys.2018.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/06/2018] [Accepted: 11/19/2018] [Indexed: 01/15/2023] Open
Abstract
QUESTIONS What are the attitudes of women diagnosed with gestational diabetes mellitus (GDM) towards physical activity during pregnancy? What are the perceived barriers to and enablers of physical activity during pregnancy in women with GDM? DESIGN A qualitative study with phenomenology and interpretative description as theoretical frameworks. PARTICIPANTS Pregnant women experiencing an uncomplicated singleton pregnancy, diagnosed with GDM, and aged 18 to 40 years were recruited using purposive sampling. METHOD Semi-structured interviews were recorded, transcribed verbatim and returned to participants for member checking. Three researchers independently and thematically analysed the qualitative data using an inductive method. Data were coded and compared, and themes were developed, discussed and defined. Recruitment continued until data saturation. Emergent themes were sent to participants and peer reviewed for confirmation. RESULTS The participants were 27 women, with mean age 32 years (SD 3), mean gestation 30 weeks (SD 5), mean pre-pregnancy body mass index 26 kg/m2 (SD 5), and born in 10 different countries. The process of communicating information about physical activity (messaging) was the main theme to emerge. Sub-themes included: wanting information about physical activity from credible sources; wanting clear, specific information about safe physical activity during a GDM pregnancy; receiving information at GDM diagnosis because this event triggered women's desire to be more physically active; understanding why physical activity is important to improving outcomes for themselves and their babies; and wanting information about flexible, convenient and practical physical activity options. CONCLUSION To feel confident and safe about being physically active during pregnancy, women with GDM wanted clear, simple and GDM-specific messages from credible sources. Health professionals can support women with a GDM pregnancy with targeted physical activity messages.
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Affiliation(s)
- Anne L Harrison
- School of Allied Health, La Trobe University, Melbourne, Australia; Physiotherapy Department, Werribee Mercy Hospital, Melbourne, Australia.
| | - Nicholas F Taylor
- School of Allied Health, La Trobe University, Melbourne, Australia; Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia
| | - Helena C Frawley
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Centre for Allied Health Research and Education, Cabrini Health, Melbourne, Australia
| | - Nora Shields
- School of Allied Health, La Trobe University, Melbourne, Australia
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Wah YYE, McGill M, Wong J, Ross GP, Harding AJ, Krass I. Self-management of gestational diabetes among Chinese migrants: A qualitative study. Women Birth 2018; 32:e17-e23. [PMID: 29693546 DOI: 10.1016/j.wombi.2018.03.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 10/29/2017] [Accepted: 03/05/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gestational diabetes mellitus is one of the most common complications of pregnancy. Women with Gestational diabetes are at increased risk of serious health outcomes, such as pre-eclampsia, obstructed labor, and the development of Type 2 diabetes later in life. Chinese migrants, the third largest cultural group in Australia, are more likely to develop Gestational diabetes than Australian-born women. However, to date, Gestational diabetes self-management has not been investigated in this population. AIM To explore the understanding and self-management experiences of Gestational diabetes among Chinese migrants. METHODS Data were collected through individual semi-structured face-to-face interviews. Participants were recruited from the antenatal clinic at the Royal Prince Alfred Hospital. Interviews were audio-recorded, transcribed verbatim and thematically analyzed. FINDINGS Although the majority of participants demonstrated a good understanding of Gestational diabetes, some did not understand the principles behind healthcare advice and faced challenges in self-management. Confusion about self-monitoring of blood glucose and fear of insulin were also evident. Participants relied on both formal and informal sources of information. Some had difficulty obtaining adequate support. Cultural influences on self-management included meeting family needs, Chinese diet and use of Chinese medicines. CONCLUSION To assist Chinese women with Gestational diabetes to better self-manage their condition, there is a need for clinicians to: (1) provide more effective diabetes education to ensure clear understanding of self-management principles; (2) actively elicit and respond to women's confusion and concerns; (3) provide women with adequate practical support; and (4) develop greater cultural awareness.
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Affiliation(s)
- Yat Yin Eric Wah
- Faculty of Pharmacy, The University of Sydney, Sydney, Australia.
| | - Margaret McGill
- Discipline of Medicine, The University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Diabetes Centre, Sydney, Australia
| | - Jencia Wong
- Discipline of Medicine, The University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Diabetes Centre, Sydney, Australia
| | - Glynis P Ross
- Discipline of Medicine, The University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Diabetes Centre, Sydney, Australia
| | | | - Ines Krass
- Faculty of Pharmacy, The University of Sydney, Sydney, Australia
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Kragelund Nielsen K, Damm P, Bygbjerg IC, Kapur A. Barriers and facilitators for implementing programmes and services to address hyperglycaemia in pregnancy in low and middle income countries: A systematic review. Diabetes Res Clin Pract 2018; 145:102-118. [PMID: 29684614 DOI: 10.1016/j.diabres.2018.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
Abstract
AIMS An estimated 87.6% of hyperglycaemia in pregnancy cases are in low and middle income countries (LMICs). The aim of this study is to review the evidence on barriers and facilitators to programmes and services addressing hyperglycaemia in pregnancy in LMICs. METHODS A systematic review and narrative synthesis was conducted based on searches in PubMed. A total of 23 qualitative and quantitative studies were included. RESULTS Barriers and facilitators exist at the health system level, individual level and social and societal levels and are often interacting. At the health system level they relate to capacity in terms of human and material resources; availability of feasible and appropriate guidelines; organisational management and referral pathways. Individual level barriers and facilitators include knowledge; risk perception; illness beliefs; financial condition; work obligations; concerns for the baby and hardship associated with services. At the social and societal level important factors are: perceptions and norms related to women's roles, mobility and health; the knowledge and support of women's social network; and structural aspects. CONCLUSIONS Numerous factors influence programmes and services addressing hyperglycaemia in pregnancy in LMICs. Thus, several components are needed to ensure detection, treatment and follow-up of women with hyperglycaemia in pregnancy.
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Affiliation(s)
- Karoline Kragelund Nielsen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Dept. of Obstetrics, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Denmark.
| | - Ib C Bygbjerg
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Anil Kapur
- World Diabetes Foundation, Gentofte, Denmark.
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Zulfiqar T, Nolan CJ, Banwell C, Young R, Boisseau L, Ingle M, Lithander FE. Barriers to a healthy lifestyle for three- to four-year-old children of Australian-born and overseas-born mothers with post-gestational diabetes: An Australian qualitative study. J Child Health Care 2018; 22:447-459. [PMID: 29444583 DOI: 10.1177/1367493518759240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children of mothers affected by gestational diabetes mellitus (GDM) are at higher risk of long-term cardio-metabolic diseases. We explore the diet and physical activity knowledge and practices of Australian-born and overseas-born mothers with GDM history, for their three- to four-year-old children following antenatal health promotion education at a tertiary hospital. We conducted face-to-face, semi-structured interviews with 8 Australian-born and 15 overseas-born mothers with a history of GDM. Findings indicated that mothers of both groups were unaware of the increased health risks of their GDM for their children and could not recall receiving specific dietary or physical activity advice aimed at future child health. Their understanding of the diet and physical activity recommendations was inconsistent. Mothers of both groups expressed concern about the lack of reiteration of child health promotion messages following childbirth, particularly at postnatal follow-up visits. Diet and physical activity of the children of overseas-born mothers were adversely affected by inadequate maternal understanding of the recommendations due to language barriers, and child weight, healthy eating, and physical activity patterns derived from their home countries. We recommend enhanced health education for women with GDM on the future child health risks and their reduction by healthy lifestyle choices. This needs to be culturally relevant and reiterated after pregnancy.
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Affiliation(s)
- Tehzeeb Zulfiqar
- 1 National Centre of Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Christopher J Nolan
- 2 ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, Australia.,3 ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Cathy Banwell
- 1 National Centre of Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Rosemary Young
- 2 ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, Australia
| | - Lynelle Boisseau
- 2 ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, Australia
| | - Martha Ingle
- 2 ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, Australia
| | - Fiona E Lithander
- 4 NIHR Bristol Biomedical Research Centre (Nutrition Theme), at University Hospitals, Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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Singh H, Soyoltulga K, Fong T, Billimek J. Delivery Outcomes, Emergency Room Visits, and Psychological Aspects of Gestational Diabetes: Results From a Community Hospital Multiethnic Cohort. DIABETES EDUCATOR 2018; 44:465-474. [DOI: 10.1177/0145721718795589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose The purpose of this study was to evaluate perinatal outcomes and experiences of managing gestational diabetes (GDM) in a multiethnic cohort from a community hospital. Methods A retrospective cohort study of 647 ethnically diverse women with GDM was conducted. Multivariable logistic regression models were used to examine ethnic differences in cesarean delivery rates and emergency department (ED) utilization during pregnancy. Semi-structured interviews were conducted to evaluate experiences of GDM and perceptions of type 2 diabetes risk. Results Significant differences were observed between sample groups in mother’s age ( P = .004), education level ( P < .001), family history of diabetes ( P < .001), and baby birthweight ( P = .004). In the fully adjusted model, controlling for maternal age, BMI category, ED utilization during pregnancy, and family history of diabetes, Southeast and East Asian women had the lowest rates of cesarean delivery and ED utilization during pregnancy, with significantly higher rates of cesarean delivery in Hispanic, non-Hispanic white, and Asian Indian women ( P < .001). There was preliminary evidence for higher ED utilization rates during pregnancy in Hispanic women with GDM (odds ratio = 3.21; 95% CI, 0.79-4.08; P = .005). Interview analyses reflected strong psychological impact of GDM diagnoses. Women expressed shock and disappointment over diagnoses and highlighted need for psychological support from health care professionals. Risk perceptions for type 2 diabetes were low. Conclusions Findings support significant ethnic differences in cesarean delivery and ED utilization among women with GDM. Qualitative analysis suggests that culturally sensitive approaches informing psychosocial support and dietary recommendations are important considerations for a diverse GDM patient population.
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Affiliation(s)
- Harsimran Singh
- Mary & Dick Allen Diabetes Center, Hoag Memorial Hospital Presbyterian, Newport Beach, California
| | | | - Taylor Fong
- University of California, Irvine, California
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Muhwava LS, Murphy K, Zarowsky C, Levitt N. Policies and clinical practices relating to the management of gestational diabetes mellitus in the public health sector, South Africa - a qualitative study. BMC Health Serv Res 2018; 18:349. [PMID: 29747657 PMCID: PMC5946476 DOI: 10.1186/s12913-018-3175-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/01/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Women with a prior gestational diabetes have an increased lifetime risk of developing type 2 diabetes. Although post-partum follow-up for GDM women is essential to prevent progression to type 2 diabetes, it is poorly attended. The need for health systems interventions to support postpartum follow-up for GDM women is evident, but there is little knowledge of actual current practice. The aim of this study was to explore current policies and clinical practices relating to antenatal and post-natal care for women with GDM in South Africa, as well as health sector stakeholders' perspectives on the barriers to -- and opportunities for -- delivering an integrated mother - baby health service that extends beyond the first week post-partum, to the infant's first year of life. METHODS Following a document review of policy and clinical practice guidelines, in-depth interviews were conducted with 11 key informants who were key policy makers, health service managers and clinicians working in the public health services in South Africa's two major cities (Johannesburg and Cape Town). Data were analysed using qualitative content analysis procedures. RESULTS The document review and interviews established that it is policy that health services adhere to international guidelines for GDM diagnosis and management, in addition to locally developed guidelines and protocols for clinical practice. All key informants confirmed that lack of postpartum follow-up for GDM women is a significant problem. Health systems barriers include fragmentation of care and the absence of standardised postnatal care for post-GDM women. Key informants also raised patient - related challenges including lack of perceived future risk of developing type 2 diabetes and non-attendance for postpartum follow up, as barriers to postnatal care for GDM women. All participants supported integrated primary health services but cautioned against overloading health workers. CONCLUSION Although there is alignment between international guidelines, local policy and reported clinical practice in the management of GDM, there is a gap in continuation of care in the postpartum period. Health systems interventions that support and facilitate active follow-up for women with prior GDM are needed if high rates of progression to type 2 diabetes are to be avoided.
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Affiliation(s)
- Lorrein Shamiso Muhwava
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Chronic Diseases Initiative for Africa (CDIA), Cape Town, South Africa
| | - Katherine Murphy
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Chronic Diseases Initiative for Africa (CDIA), Cape Town, South Africa
| | - Christina Zarowsky
- Chronic Diseases Initiative for Africa (CDIA), Cape Town, South Africa
- University of Montreal, Hospital Research Centre and University of Montreal School of Public Health, Montreal, Canada
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Naomi Levitt
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Chronic Diseases Initiative for Africa (CDIA), Cape Town, South Africa
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Figueroa Gray M, Hsu C, Kiel L, Dublin S. "It's a Very Big Burden on Me": Women's Experiences Using Insulin for Gestational Diabetes. Matern Child Health J 2018; 21:1678-1685. [PMID: 28092062 DOI: 10.1007/s10995-017-2261-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives Gestational Diabetes Mellitus (GDM) affects hundreds of thousands of women each year. Many require medications to manage their blood glucose levels. Only insulin is approved by the U.S. Food and Drug Administration for use in pregnancy. While other medications can be used, their safety remains controversial. Few studies have examined women's lived experience of using insulin for GDM. Our objective in this study was to foreground the voices of women speaking about their treatment experience. Methods We conducted two focus groups including 16 women treated for GDM with medications, primarily insulin. Topics included women's experiences with GDM diagnosis and treatment including concerns about risks and benefits of treatments. Transcripts were analyzed using an inductive coding approach. Results Many women had negative experiences with insulin use, such as feeling that they had no voice in treatment decisions, and received inadequate information about insulin, including about the impact it would have on their daily lives. Many continued to have difficulty managing their blood sugar once on insulin, and they worried about the short term and long term health effects of insulin on themselves and their babies. They wanted more information about non-insulin treatment options as well as more social support. Conclusion In our sample of women with GDM, insulin treatment resulted in negative experiences with emotional and experiential impacts lasting beyond pregnancy. There is a need for more research on other medications for GDM, so that women can have access to more treatment options and better information to guide their choices.
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Affiliation(s)
| | - Clarissa Hsu
- Group Health Research Institute, 1730 Minor Avenue, Suite 1280, Seattle, WA, USA
| | - Linda Kiel
- Group Health Research Institute, 1730 Minor Avenue, Suite 1280, Seattle, WA, USA
| | - Sascha Dublin
- Group Health Research Institute, 1730 Minor Avenue, Suite 1280, Seattle, WA, USA
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Kolivand M, Keramat A, Rahimi M, Motaghi Z, Shariati M, Emamian M. Self-care Education Needs in Gestational Diabetes Tailored to the Iranian Culture: A Qualitative Content Analysis. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2018; 23:222-229. [PMID: 29861762 PMCID: PMC5954645 DOI: 10.4103/ijnmr.ijnmr_108_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Gestational diabetes is one of the most common health problems in pregnancy that requires participation through self-care to reduce the maternal and neonatal complications. The present study aimed to determine the needs of women as an essential first step to formulate a self-care guide fitting the Iranian culture. Materials and Methods: The present qualitative study was conducted through interviews with 13 diabetic pregnant women and 10 care providers using semi-structured questionnaires in several cities of Iran in 2016. Further, the data analysis was performed using conventional content analysis. In addition, purposive sampling was performed at the diabetes clinic of Kermanshah University of Medical Sciences, Imam Reza Hospital, and health centers across Kermanshah, Shahroud, and Tehran. Results: In the present qualitative content analysis study, four themes were identified: awareness and ability (knowing diabetes, mothers training and empowerment, continuity and quality, information resources), lifestyle (healthy diet, physical activity), mental health (counseling, interaction, spirituality, and religion), and supportive family (the husband's unique role, the psychological atmosphere at home). Conclusions: The present study highlighted main aspects of self-care educational/supportive needs, specifically in the domains of lifestyle, awareness and capability, mental health, and family. The results of our analysis highlighted the needs that can be useful for developing comprehensive self-care educational programs, with a higher focus on physical activity, mental health, the role of the family, and the use of religious interests.
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Affiliation(s)
- Mitra Kolivand
- Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Afsaneh Keramat
- Reproductive Studies and Women's Health Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - MehrAli Rahimi
- Department of Internal Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zahra Motaghi
- Department of Midwifery, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mohammad Shariati
- Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - MohammadHassan Emamian
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
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Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review. J Physiother 2018; 64:24-32. [PMID: 29289592 DOI: 10.1016/j.jphys.2017.11.012] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 12/11/2022] Open
Abstract
QUESTION What are the attitudes, barriers and enablers to physical activity perceived by pregnant women? DESIGN In a systematic literature review, eight electronic databases were searched: AMED, CINAHL, Embase, Joanna Briggs Institute, Medline, PsycInfo, SPORTDiscus (from database inception until June 2016) and PubMed (from 2011 until June 2016). Quantitative data expressed as proportions were meta-analysed. Data collected using Likert scales were synthesised descriptively. Qualitative data were analysed thematically using an inductive approach and content analysis. Findings were categorised as intrapersonal, interpersonal or environmental, based on a social-ecological framework. PARTICIPANTS Pregnant women. INTERVENTION Not applicable. OUTCOME MEASURES Attitudes and perceived barriers and enablers to physical activity during pregnancy. RESULTS Forty-nine articles reporting data from 47 studies (7655 participants) were included. Data were collected using questionnaires, interviews and focus groups. Meta-analyses of proportions showed that pregnant women had positive attitudes towards physical activity, identifying it as important (0.80, 95% CI 0.52 to 0.98), beneficial (0.71, 95% CI 0.58 to 0.83) and safe (0.86, 95% CI 0.79 to 0.92). This was supported by themes emerging in 15 qualitative studies that reported on attitudes (important, 12 studies; beneficial, 10 studies). Barriers to physical activity were predominantly intrapersonal such as fatigue, lack of time and pregnancy discomforts. Frequent enablers included maternal and foetal health benefits (intrapersonal), social support (interpersonal) and pregnancy-specific programs. Few environmental factors were identified. Little information was available about attitudes, barriers and enablers of physical activity for pregnant women with gestational diabetes mellitus who are at risk from inactivity. CONCLUSION Intrapersonal themes were the most frequently reported barriers and enablers to physical activity during pregnancy. Social support also played an enabling role. Person-centred strategies using behaviour change techniques should be used to address intrapersonal and social factors to translate pregnant women's positive attitudes into increased physical activity participation. REGISTRATION PROSPERO CRD42016037643. [Harrison AL, Taylor NF, Shields N, Frawley HC (2018) Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review. Journal of Physiotherapy 64: 24-32].
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Svensson L, Nielsen KK, Maindal HT. What is the postpartum experience of Danish women following gestational diabetes? A qualitative exploration. Scand J Caring Sci 2017; 32:756-764. [PMID: 28856697 DOI: 10.1111/scs.12506] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/19/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Women with gestational diabetes mellitus (GDM) receive acute but short-term care during pregnancy. There is less direct support during the postpartum period; women are offered general advice on how to follow a healthy lifestyle to avoid developing future type 2 diabetes. Observational studies suggest that a substantial proportion of women with prior GDM do not sustain recommended lifestyle changes postpartum. In a qualitative study, we examined how Danish women diagnosed with GDM experience the transition from a GDM-affected pregnancy to the postpartum period. METHODS Semistructured interviews with six women diagnosed with GDM. Data were analysed using qualitative content analysis. RESULTS A GDM diagnosis was accompanied by worries about the health of the woman's baby. This was also the driving force behind the women's motivation to engage in lifestyle changes during pregnancy. The outpatient treatment was perceived to be strict and associated with various challenges, including cravings and discomfort. After the delivery, taking care of the baby became the women's dominant focus. Social and emotional support from partners were needed to maintain motivation and prioritise a healthy lifestyle. The women's experience of the health system varied. However, in the postpartum period all the women experienced limited interaction and initiative from their healthcare providers in supporting them to engage in a healthy lifestyle. CONCLUSIONS This study identified barriers and facilitators to sustaining a healthy lifestyle postpartum. Efforts at multiple levels - including the individual, family and health system - are needed to facilitate and support a healthy lifestyle among women with prior GDM.
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Affiliation(s)
- Line Svensson
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Karoline Kragelund Nielsen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
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Youngwanichsetha S, Phumdoung S. Lived experience of blood glucose self-monitoring among pregnant women with gestational diabetes mellitus: a phenomenological research. J Clin Nurs 2017; 26:2915-2921. [DOI: 10.1111/jocn.13571] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2016] [Indexed: 11/27/2022]
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Zulfiqar T, Lithander FE, Banwell C, Young R, Boisseau L, Ingle M, Nolan CJ. Barriers to a healthy lifestyle post gestational-diabetes: An Australian qualitative study. Women Birth 2017; 30:319-324. [PMID: 28169159 DOI: 10.1016/j.wombi.2016.12.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/25/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Overseas-born-women from certain ethnicities are at high risk of type-2 diabetes and related metabolic disorders. This study explored the barriers and facilitators to long-term healthy lifestyle recommendations among Australian-born and overseas-born-women who attended health promotion sessions at a tertiary Australian Hospital for gestational diabetes 3-4 years previously. METHOD Face-to-face semi-structured interviews were conducted. Data were analyzed to identify major themes and the differing experiences of both groups of women. FINDINGS Women in both groups faced many barriers to improve post-gestational-diabetes lifestyle. Women from both groups recalled healthy lifestyle recommendations for during pregnancy they received at the service, but had difficulty recalling the long-term lifestyle recommendations. Timing of the health information, non-reiteration of lifestyle recommendations, uncoordinated and fragmented health system support after childbirth were barriers faced by all women. Additional barriers for overseas-born women included the cultural competence of the health education material, their cultural preferences for food and physical activities and unsupportive family and partner. Both groups had excellent compliance with the first annual postnatal oral-glucose-tolerance-test. This was attributed to the personal motivation and health professional reminder. Women only reverted to the healthy lifestyles postnatally for weight loss. CONCLUSION A better understanding of the barriers to healthy lifestyle by women in their everyday lives will assist in the development of culturally appropriate health promotion guidelines and strategies. Constant un-fragmented postnatal engagement by the specialised diabetes clinics and primary health care services is crucial to sustain the healthy lifestyle in the long-term for women with previous gestational-diabetes.
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Affiliation(s)
- Tehzeeb Zulfiqar
- National Centre of Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia; ANU College of Medicine, Biology and Environment, Australian National University, Canberra, ACT, Australia.
| | - Fiona E Lithander
- NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, UK.
| | - Cathy Banwell
- National Centre of Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia.
| | - Rosemary Young
- ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, ACT, Australia.
| | - Lynelle Boisseau
- ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, ACT, Australia.
| | - Martha Ingle
- ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, ACT, Australia.
| | - Christopher J Nolan
- ANU College of Medicine, Biology and Environment, Australian National University, Canberra, ACT, Australia; ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, ACT, Australia.
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