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Bradford BF, Cronin RS, Okesene-Gafa KA, Apaapa-Timu THS, Shashikumar A, Oyston CJ. Diabetes in pregnancy: Women's views of care in a multi-ethnic, low socioeconomic population with midwifery continuity-of-care. Women Birth 2024; 37:101579. [PMID: 38296743 DOI: 10.1016/j.wombi.2024.01.005] [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: 09/27/2023] [Revised: 12/10/2023] [Accepted: 01/14/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Diabetes in pregnancy is diagnosed in 6% of pregnancies annually in Aotearoa-New Zealand, disproportionately affecting multi-ethnic, low socio-economic women. Little is known about the care experience of this population within the model of midwifery continuity-of-care, including views of telehealth care. AIM Increase understanding of the experience of diabetes in pregnancy care, including telehealth, among multi-ethnic, low socio-economic women receiving midwifery continuity-of-care. METHODS Qualitative interview study with primarily indigenous and migrant women who had diabetes in pregnancy and gave birth 6-18 months previously. Interviewers were matched with participants by ethnicity. Transcripts were analysed using Framework analysis. RESULTS Participants were 19 women (5 Māori, 5 Pacific Peoples, 5 Asian, 4 European). Data analysis revealed three key themes: 1) 'shock, shame, and adjustment' to the diagnosis 2) 'learning to manage diabetes in pregnancy' and 3) 'preparation for birth and beyond' to the postpartum period. DISCUSSION Receiving the diagnosis of diabetes in pregnancy was a shock. Managing diabetes during pregnancy was particularly challenging for indigenous and migrant women, who wished for better access to culturally appropriate dietary and lifestyle information. Women appreciated having options of telehealth and face-to-face consultations. Preparation for birth and postpartum diabetes follow-up were areas requiring significant improvement. Challenges were mitigated through care from a consistent diabetes specialist midwife and community-based midwifery continuity-of-care. CONCLUSION Midwives were the backbone of diabetes in pregnancy care for this multi-ethnic, low socio-economic population. Care could be improved with more culturally appropriate diet and lifestyle information, better birth preparation, and expanded postpartum diabetes support.
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Affiliation(s)
- Billie F Bradford
- Obstetrics & Gynaecology, Monash Health, Monash University, Australia
| | - Robin S Cronin
- Te Whatu Ora Counties Manukau, Health New Zealand, New Zealand; Department of Obstetrics and Gynecology, University of Auckland, New Zealand
| | - Karaponi A Okesene-Gafa
- Te Whatu Ora Counties Manukau, Health New Zealand, New Zealand; Department of Obstetrics and Gynecology, University of Auckland, New Zealand
| | - Te Hao S Apaapa-Timu
- Te Whatu Ora Counties Manukau, Health New Zealand, New Zealand; Department of Obstetrics and Gynecology, University of Auckland, New Zealand
| | - Asha Shashikumar
- Department of Obstetrics and Gynecology, University of Auckland, New Zealand
| | - Charlotte J Oyston
- Te Whatu Ora Counties Manukau, Health New Zealand, New Zealand; Department of Obstetrics and Gynecology, University of Auckland, New Zealand.
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Davis D, Kurz E, Hooper ME, Atchan M, Spiller S, Blackburn J, Bushell M, Lewis V, Leung M, Samarawickrema I, Knight-Agarwal C. The holistic maternity care needs of women with Gestational Diabetes Mellitus: A systematic review with thematic synthesis. Women Birth 2024; 37:166-176. [PMID: 37684120 DOI: 10.1016/j.wombi.2023.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023]
Abstract
PROBLEM Models of care for women with gestational diabetes mellitus (GDM) have evolved in an ad hoc way and do not meet women's needs. BACKGROUND GDM affects 50,000 Australian women per annum with prevalence quadrupling in the last ten years. Many health services are struggling to provide a quality service. People with diabetes are calling for care that focuses on their wellbeing more broadly. AIM To examine the holistic (emotional, social, economic, and spiritual) care needs of women with GDM. METHODS Qualitative and mixed-methods studies capturing the healthcare experiences of women with GDM were searched for in CINAHL, Medline, Web of Science and Scopus. English-language studies published between 2011 and 2023 were included. Quality of studies was assessed using Crowe Critical Appraisal Tool and NVIVO was used to identify key themes and synthesise data. FINDINGS Twenty-eight studies were included, representing the experiences of 958 women. Five themes reflect women's holistic needs through their journey from initial diagnosis to postpartum: psychological impact, information and education, making change for better health, support, and care transition. DISCUSSION The biomedical, fetal-centric model of care neglects the woman's holistic wellbeing resulting in high levels of unmet need. Discontinuity between tertiary and primary services results in a missed opportunity to assist women to make longer term changes that would benefit themselves (and their families) into the future. CONCLUSIONS The provision of holistic models of care for this cohort is pivotal to improving clinical outcomes and the experiences of women with GDM.
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Affiliation(s)
- Deborah Davis
- University of Canberra, Faculty of Health, Australia; ACT Government, Health Directorate, Australia.
| | - Ella Kurz
- University of Canberra, Faculty of Health, Australia
| | | | | | | | | | - Mary Bushell
- University of Canberra, Faculty of Health, Australia
| | | | - Myra Leung
- University of Canberra, Faculty of Health, Australia
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He J, Wang H, Chen X. Experiences and self-care of pregnant nurses with gestational diabetes mellitus: a qualitative study. BMC Nurs 2024; 23:33. [PMID: 38212724 PMCID: PMC10782759 DOI: 10.1186/s12912-023-01679-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Pregnant nurses are at high risk of developing gestational diabetes mellitus (GDM), and nurses diagnosed with GDM face challenges in balancing disease management and work, which affects maternal and child health and the quality of care. GDM requires significant changes to lifestyle and physical activity to control blood glucose levels, which is key to reducing adverse pregnancy outcomes. However, few studies have focused on the experiences of pregnant nurses with GDM. This study aimed to gain insight into the experiences of pregnant nurses with GDM in China in terms of their illness, work burdens, and self-care. METHODS This qualitative study used an interpretative phenomenological analysis. Face-to-face semi-structured in-depth interviews were conducted with pregnant nurses with GDM to investigate their experiences and self-care. The study was performed at Chongqing's maternal and child health hospital in China. A purposive sampling was used. Nine pregnant nurses diagnosed with GDM were recruited and interviewed. RESULTS The interview data generated four themes and 11 sub-themes. The four themes were 'the perceptions and feelings of GDM', 'experiences of lifestyle changes', 'social support needs', and 'health expectations and risk perception.' CONCLUSION Many factors such as the unique occupational environment, overwork, occupational pressure, shift work, family status, and education level may lead to difficulties in managing blood glucose in nurses with GDM. These findings suggest that managers should pay more attention to nurses with GDM and develop personalized medical care and work arrangements. These measures can improve the self-care and well-being of nurses with GDM and promote the health of nurses and their offspring.
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Affiliation(s)
- Jing He
- Nursing department, Tongji Hospital of Tongji Medical College of Huazhong, University of Science and Technology, NO.1095 Jiefang Avenue, Wuhan, China
- School of Nursing, Tongji Medical College of Huazhong, University of Science and Technology, NO.13 Aviation Road, Wuhan, China
- School of Nursing, Wuhan University, NO. 115 Donghu Road, Wuhan, China
| | - Hui Wang
- Nursing department, Tongji Hospital of Tongji Medical College of Huazhong, University of Science and Technology, NO.1095 Jiefang Avenue, Wuhan, China.
| | - Xiaoli Chen
- School of Nursing, Wuhan University, NO. 115 Donghu Road, Wuhan, China.
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Lau HWR, Dong J, Weir T, Chopra M, Olivetti L, Fulcher G, Glastras S. Improving women's experiences with gestational diabetes from culturally and linguistically diverse backgrounds in Australia: a qualitative study. Front Public Health 2024; 11:1291347. [PMID: 38292381 PMCID: PMC10826118 DOI: 10.3389/fpubh.2023.1291347] [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: 09/09/2023] [Accepted: 12/15/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Gestational diabetes mellitus (GDM) is the fastest growing type of diabetes in many countries worldwide, including Australia. Although studies have explored the experiences of women with GDM from ethnic minority groups, few have compared their experiences with women from Anglosphere backgrounds. Objective To investigate the responses to diagnosis, the management of GDM, and the experiences of healthcare services among women with GDM from different culturally and linguistically diverse (CALD) backgrounds. Methods Participants were recruited via convenience sampling by advertisement posted around antenatal clinics of three hospitals in NSLHD: Royal North Shore, Hornsby, and Manly Hospitals. The interviews were semi-structured, one-on-one, and in-person conducted by a trained female volunteer. The interviews were audio-recorded, transcribed into text. The data was analyzed via an inductive and descriptive coding approach. The codes were then categorized into main themes and sub-themes. Results 30 women (7 Australian-born, 11 Chinese, 8 Indians, and 4 Koreans) partook the semi-structured interviews and 5 themes were identified: (1) Reaction to diagnosis; (2) Management issues; (3) Roles of friends and family; (4) Information access; and (5) Experience with healthcare services. The lack of culturally tailored dietary information, social support and language barriers were the main factors underpinning the differences in GDM experiences among women from CALD backgrounds versus Australian-born. Conclusion Healthcare models should provide more emotional support upon diagnosis, culturally tailored guidelines for lifestyle modifications, and involve friends and family in care and management to enhance the experience of GDM for women from CALD backgrounds.
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Affiliation(s)
| | - Johnathon Dong
- Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
- North Sydney Endocrine Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Tessa Weir
- Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
- Endocrinology Outpatient Clinic Service, Nepean Blue Mountains Hospital, Penrith, NSW, Australia
| | - Meenakshi Chopra
- Integrated Digital Enablement Accelerator (IDEA) Team, NSW Ministry of Health, St Leonards, NSW, Australia
| | - Lyn Olivetti
- Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Gregory Fulcher
- North Sydney Endocrine Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Sarah Glastras
- North Sydney Endocrine Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
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Yamada K, Endo M, Ohashi K. Depression and diet-related distress among Japanese women with gestational diabetes mellitus. Nurs Health Sci 2023; 25:609-618. [PMID: 37772678 DOI: 10.1111/nhs.13054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 08/26/2023] [Accepted: 09/17/2023] [Indexed: 09/30/2023]
Abstract
Although the association between gestational diabetes mellitus (GDM) and maternal postpartum depression has been reported, the association between these two factors during pregnancy has not been sufficiently examined. We compared pregnant women with and without GDM to clarify the association and examined factors related to depression in pregnant women with GDM. Questionnaires were administered longitudinally to pregnant Japanese women in the third trimester and at 2 and 4 weeks postpartum. One hundred and five and 108 pregnant women with and without GDM, respectively, were included in the study. Of the 105 women with GDM, 20 (19.0%) reported being depressed during pregnancy, which was significantly higher than that among those without GDM (9.3%). Binomial logistic regression analysis revealed that depression was significantly positively associated with diet-related distress and negatively associated with social support among women with GDM. Diet-related distress and social support are important factors in managing depression in pregnant women with GDM.
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Affiliation(s)
- Kanako Yamada
- Graduate School of Nuring, Osaka Metropolitan University, Osaka, Japan
- Division of Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masayuki Endo
- Division of Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan
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Yang X, Han R, Xiang Z, Li H, Zhao Q, Chen L, Gao L. Clinical practice guidelines on physical activity and exercise for pregnant women with gestational diabetes mellitus: A systematic review. Int J Nurs Pract 2023; 29:e13141. [PMID: 36929054 DOI: 10.1111/ijn.13141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 01/11/2023] [Accepted: 01/27/2023] [Indexed: 03/18/2023]
Abstract
AIM This review aimed to appraise clinical guidelines about exercise for women with gestational diabetes mellitus and summarize consensus and inconsistent recommendations. BACKGROUND Exercise is an effective non-pharmacological therapeutic for gestational diabetes mellitus, but the variety of relevant clinical practice guidelines is confusing for healthcare professionals. DESIGN This is a systematic review of clinical practice guidelines. DATA SOURCES Websites of guideline development institutions, eight literature databases and organizations of obstetricians, gynaecologists, midwives, and medical sports associations were searched for guidelines published from January 2011 to October 2021. REVIEW METHODS Two reviewers independently extracted recommendations. Four reviewers assessed guideline quality using the AGREE II instrument independently. RESULTS Fifteen guidelines were included. All women with diabetes are recommended to exercise during pregnancy. The consistent recommendations were for pre-exercise screening, for 30 min per exercise session on 5 days of the week or every day after meals, exercise at moderate intensity, using aerobic and resistance exercise, and walking. The main non-consistent recommendations included warning signs for women on insulin during exercise, minimum duration per session, intensity assessment, duration and frequency of sessions for strengthening and flexibility exercise and detailed physical activity giving birth. CONCLUSIONS Guidelines strongly support pregnant women with diabetes to exercise regularly. Research is needed to make non-consistent recommendations clear.
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Affiliation(s)
- Xiao Yang
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Rongrong Han
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Zhixuan Xiang
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Hanbing Li
- School of Nursing, University of South China, Hengyang, China
| | - Qian Zhao
- Office of the Dean (Party Committee), Gem Flower Xi'an Changqing Staff Hospital, Xi'an, China
| | - Lu Chen
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Lingling Gao
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
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Smyth S, Mulligan K, Rutter E, Harrington L, Hatunic M, Higgins MF. Attitudes of women with gestational diabetes toward diet and exercise: a qualitative study. J Matern Fetal Neonatal Med 2023; 36:2155045. [PMID: 36599434 DOI: 10.1080/14767058.2022.2155045] [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: 09/30/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Gestational diabetes (GDM) refers to glucose intolerance of varying severity first occurring in pregnancy. Following a diagnosis of GDM, exercise and dietary modification has a positive effect on improving glycemic control. Lifestyle changes affected in pregnancies affected by GDM have beneficial effects on long-term health if continued following birth. In addition, the psychological impact of a diagnosis of GDM should not be overlooked. Reports of maternal stress, anxiety, and fear are commonly reported issues in the literature. Support, both socially and from health care professionals, is also linked with higher rates of success in GDM management. Research to date had focused on women's reaction to a diagnosis of GDM, their mood and quality of life following a diagnosis, and their knowledge or opinions on the management of GDM. This qualitative study explored the attitudes of women with GDM toward these lifestyle changes, specifically diet and exercise. Women were also asked to identify advice that would be useful for other women newly diagnosed with GDM. METHODS With ethical approval a qualitative study was conducted using semi-structured interviews which were examined using Thematic Analysis. Patients were invited to participate and gave written consent after a discussion with a study researcher. The question plan for semi-structured interviews was designed with the advice of patient advocates. Recurrent themes were developed until the saturation of data. RESULTS Thirty-two women took part in the study. Time, convenience, and lack of educational awareness were common barriers to healthy eating and physical activity plans. Enablers for change included meal planning and organization. Women regarded their diets pre-diagnosis as healthy, with small "tweaks" (such as portion control) required to comply with recommendations. Another significant facilitator to change was support from the woman's partner. This also set a benchmark for plans of diet maintenance within the family structure after pregnancy. Unlike dietary changes, a consistent theme was that exercise was considered a "chore" in managing GDM and was unlikely to be continued in the long term. Practical advice offered by participants for other women with GDM included organization, realistic approaches, and lack of self-blame. CONCLUSION Women reported that changes in diet would be more achievable in the long term than changes in exercise patterns. Partners and the clinical team were significant sources of support. Women's views are crucial to providing clinicians with a comprehensive and holistic understanding of disease management. Involving women in self-care decisions and empowering women to manage their own health are key contributors to long-term behavior change as well as service provision and policy implementation.
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Affiliation(s)
- S Smyth
- UCD Perinatal Research Center, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Republic of Ireland
| | - K Mulligan
- UCD Perinatal Research Center, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Republic of Ireland
| | - E Rutter
- Department of Midwifery, National Maternity Hospital, Dublin, Republic of Ireland
| | - L Harrington
- Department of Dietetics, National Maternity Hospital, Dublin, Republic of Ireland
| | - M Hatunic
- Department of Endocrinology, National Maternity Hospital and Mater Misercordiae Hospital, Dublin, Republic of Ireland
| | - M F Higgins
- UCD Perinatal Research Center, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Republic of Ireland
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Kitchen C, Kabba JA, Nelson EU, Adu-Gyamfi S, Ssekamatte T, Mametja M, Yang C, Chang J, Fang Y. Medicinal use of cannabis: A qualitative study of the perspectives of doctors and pharmacists from six African countries. J Ethn Subst Abuse 2023:1-25. [PMID: 37791493 DOI: 10.1080/15332640.2023.2259830] [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: 10/05/2023]
Abstract
We conducted a qualitative study to examine the enablers and barriers influencing the implementation of medical cannabis from the perspectives of practicing doctors and pharmacists within the African context. Interviews were conducted to investigate medical professionals' perceptions and concerns regarding medicinal cannabis. Three major themes were identified: beliefs about consequences, optimism, and environmental resources and context. Depending on the context of use, medical professionals described cannabis as potentially useful as an adjunct medicine and yet problematic owing to knowledge and social barriers, particularly religion. Implementation strategies tailored to address structural and social concerns to providing optimal care are needed to ensure that medical professionals are well versed in policy and clinical aspects.
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Affiliation(s)
- Chenai Kitchen
- Xi'an Jiaotong University, Xi'an, China
- Western Technological Innovation Harbour, Xi'an, China
| | - John Alimamy Kabba
- Xi'an Jiaotong University, Xi'an, China
- Western Technological Innovation Harbour, Xi'an, China
| | | | | | | | | | - Caijun Yang
- Xi'an Jiaotong University, Xi'an, China
- Western Technological Innovation Harbour, Xi'an, China
| | - Jie Chang
- Xi'an Jiaotong University, Xi'an, China
- Western Technological Innovation Harbour, Xi'an, China
| | - Yu Fang
- Xi'an Jiaotong University, Xi'an, China
- Western Technological Innovation Harbour, Xi'an, China
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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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Sun S, Pellowski J, Pisani C, Pandey D, Go M, Chu M, Ruan J, Werner EF. Experiences of stigma, psychological distress, and facilitative coping among pregnant people with gestational diabetes mellitus. BMC Pregnancy Childbirth 2023; 23:643. [PMID: 37679726 PMCID: PMC10486063 DOI: 10.1186/s12884-023-05949-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) has been rising in the United States, and it poses significant health risks to pregnant individuals and their infants. Prior research has shown that individuals with GDM also experience prevalent stress and mental health issues, which can further contribute to glucose regulation difficulties. Stigma associated with GDM may contribute to these mental health challenges, yet there is a lack of focused research on GDM-related stigma, its impact on psychological health, and effective coping mechanisms. Thus, this qualitative study aims to understand individuals' experiences related to GDM stigma, mental health, and facilitative coping. METHODS In-depth, semi-structured interviews were conducted with 14 individuals with a current or recent (within the last year) diagnosis of GDM. Thematic analysis was employed to guide data analysis. RESULTS Four themes emerged from data analysis: (1) experience of distal GDM stigma including stigmatizing provider interactions, stigma from non-medical spaces, and intersecting stigma with weight, (2) internalized GDM stigma, such as shame, guilt, and self-blame, (3) psychological distress, which included experiences of stress and overwhelm, excessive worry and fear, and loneliness and isolation, and (4) facilitative coping mechanisms, which included diagnosis acceptance, internet-based GDM community, active participation in GDM management, social and familial support, and time for oneself. CONCLUSIONS Findings demonstrate the relevance of GDM stigma in mental health among people with GDM and the need for addressing GDM stigma and psychological health in this population. Interventions that can reduce GDM stigma, improve psychological wellness, and enhance positive coping may facilitate successful GDM management and healthy birth outcomes. Future quantitative, theory-driven research is needed to understand the prevalence of GDM stigma experiences and mechanisms identified in the current study, as well as among marginalized populations (e.g., individuals of color, sexual and gender minorities).
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Affiliation(s)
- Shufang Sun
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main St, Providence, RI, 02903, USA.
- International Health Institute, Brown University School of Public Health, Providence, USA.
- Mindfulness Center, Brown University School of Public Health, Providence, USA.
| | - Jennifer Pellowski
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main St, Providence, RI, 02903, USA
- International Health Institute, Brown University School of Public Health, Providence, USA
| | | | - Diksha Pandey
- Watson Institute for International and Public Affairs, Brown University, Providence, USA
| | - Mallory Go
- The College at Brown University, Providence, USA
| | - MyDzung Chu
- Tufts Clinical and Translational Science Institute, Boston, USA
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, USA
| | - Jenny Ruan
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, USA
- Tufts University School of Medicine, Boston, USA
| | - Erika F Werner
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, USA
- Tufts University School of Medicine, Boston, USA
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Laursen SH, Boel L, Udsen FW, Secher PH, Andersen JD, Vestergaard P, Hejlesen OK, Hangaard S. Effectiveness of Telemedicine in Managing Diabetes in Pregnancy: A Systematic Review and Meta-Analysis. J Diabetes Sci Technol 2023; 17:1364-1375. [PMID: 35533131 PMCID: PMC10563542 DOI: 10.1177/19322968221094626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Strict monitoring of blood glucose during pregnancy is essential for ensuring optimal maternal and neonatal outcomes. Telemedicine could be a promising solution for supporting diabetes management; however, an updated meta-analysis is warranted. This study assesses the effects of telemedicine solutions for managing gestational and pregestational diabetes. METHODS PubMed, EMBASE, Cochrane Library Central Register of Controlled Trials, and CINAHL were searched up to October 14, 2020. All randomized trials assessing the effects of telemedicine in managing diabetes in pregnancy relative to any comparator without the use of telemedicine were included. The primary outcome was infant birth weight. A meta-analysis comparing the mean difference (MD) in birth weight across studies was applied, and subgroup and sensitivity analyses were performed. The revised Cochrane tool was applied to assess the risk of bias, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. RESULTS From a total of 18 studies, ten (totaling 899 participants) were used to calculate the effect on infant birth weight. The results nonsignificantly favored the control (MD of 19.34 g; [95% confidence interval, CI -47.8; 86.47]), with moderate effect certainty. Heterogeneity was moderate (I2 = 37.39%). Statistically significant secondary outcomes included differences in two-hour glucose tolerance postpartum (gestational diabetes; two studies: standardized mean difference 9.62 mg/dL [95% CI: 1.95; 17.28]) that favored the control (GRADE level, very low) and risk of shoulder dystocia (four studies: log odds -1.34 [95% CI: -2.61; -0.08]) that favored telemedicine (GRADE, low). CONCLUSIONS No evidence was found to support telemedicine as an alternative to usual care when considering maternal and fetal outcomes. However, further research is needed, including economic evaluations.
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Affiliation(s)
- Sisse H. Laursen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- University College of Northern Denmark, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Lise Boel
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Flemming W. Udsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Pernille H. Secher
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jonas D. Andersen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Ole K. Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Stine Hangaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
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Sangtani A, Owens L, Broome DT, Gogineni P, Herman WH, Harris LH, Oshman L. The Impact of New and Renewed Restrictive State Abortion Laws on Pregnancy-Capable People with Diabetes. Curr Diab Rep 2023; 23:175-184. [PMID: 37213059 DOI: 10.1007/s11892-023-01512-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE OF REVIEW When the Supreme Court handed down its decision in Dobbs v Jackson Women's Health Organization in June 2022, the constitutional right to abortion was no longer protected by Roe v Wade. Fifteen states now have total or near-total bans on abortion care or no clinics providing abortion services. We review how these restrictions affect the medical care of people with pregestational diabetes. RECENT FINDINGS Of the ten states with the highest percent of adult women living with diabetes, eight currently have complete or 6-week abortion bans. People with diabetes are at high risk of diabetes-related pregnancy complications and pregnancy-related diabetes complications and are disproportionately burdened by abortion bans. Abortion is an essential part of comprehensive, evidence-based diabetes care, yet no medical society has published guidelines on pregestational diabetes that explicitly discuss the importance and role of safe abortion care. Medical societies enacting standards for diabetes care and clinicians providing diabetes care must advocate for access to abortion to reduce pregnancy-related morbidity and mortality for pregnant people with diabetes.
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Affiliation(s)
- Ajleeta Sangtani
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Lauren Owens
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - David T Broome
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Preethi Gogineni
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - William H Herman
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Lisa H Harris
- Department of Obstetrics and Gynecology and Department of Women's and Gender Studies, University of Michigan, Ann Arbor, MI, USA
| | - Lauren Oshman
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
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Al Nadhiri M, Al Hashmi I, Alaloul F, Al Omari O. Adherence to gestational diabetes mellitus (GDM) management plan among pregnant women in Oman: Predictors, barriers, and motivating factors. Diabetes Metab Syndr 2023; 17:102766. [PMID: 37146357 DOI: 10.1016/j.dsx.2023.102766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVES This study examined the predictors, the barriers, and the motivating factors of adherence to the gestational diabetes mellitus (GDM) management plan among Arab pregnant women with GDM. METHODS This cross-sectional study was conducted in the Antenatal Clinics of three major tertiary hospitals in Oman. Total of 164 Arab pregnant women with GDM were recruited using a convenience sampling technique. The measurement scales included Diabetes Self-Management Questionnaire- Revised, Diabetes Management Self-Efficacy Scales, and Social Support Survey. Multiple-choice questions were used to assess barriers to and motivators of adherence. The analytical tools included multiple linear regression and descriptive statistics. RESULTS Findings from stepwise regression analysis revealed three models with three significant predictors, including self-efficacy, previous history of GDM, and the type of GDM management. The major barriers to adherence were family, especially kids' responsibilities, time constraints, home responsibilities, and working status. Moreover, participants indicated their concern about maternal and neonatal GDM-related complications and husband encouragement as the main motivating factors for adherence. CONCLUSIONS and Clinical Relevance: Our findings suggest that antenatal healthcare providers should implement strategies that enhance self-efficacy and engage families in health education programs. The study also recommends collaboration between health policy makers in the Ministries of Health, Consumer Protection Agency, and the Ministries of Municipality to ensure the availability of healthy food choices in the public areas. Additionally, flexible working conditions and an environment conducive to a healthy and active lifestyle should be made available to pregnant women with GDM.
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Affiliation(s)
- Marwa Al Nadhiri
- Al Kodh 66, Sultan Qaboos University Hospital, Muscat, Oman, 123.
| | - Iman Al Hashmi
- Al Kodh 66, College of Nursing, Sultan Qaboos University, Muscat, Oman, 123.
| | - Fawwaz Alaloul
- Al Kodh 66, College of Nursing, Sultan Qaboos University, Muscat, Oman, 123.
| | - Omar Al Omari
- Al Kodh 66, College of Nursing, Sultan Qaboos University, Muscat, Oman, 123.
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14
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Mensah GP, van Rooyen D(R, ten Ham-Baloyi W. Screening and nursing management of gestational diabetes in Ghana: Evidence-based recommendations. Heliyon 2023; 9:e15351. [PMID: 37123949 PMCID: PMC10130854 DOI: 10.1016/j.heliyon.2023.e15351] [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: 03/10/2023] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023] Open
Abstract
Objective To describe the development of evidence-based recommendations for screening and nursing management of gestational diabetes mellitus (GDM) in Ghana and present the recommendations. Design A qualitative study. Setting Military Health Institutions in Ghana. Measurements Data from qualitative interviews with 7 women with GDM and 8 midwives, and an integrative literature review including available clinical practice guidelines on screening and nursing management of GDM, was used to develop the recommendations. The National Institute for Health and Care Excellence' steps guided the recommendations' development. Methodological quality of the recommendations was assessed based on an adapted version of the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Six experts reviewed the recommendations and an infographic in support of the recommendations. Findings Two main recommendations and an infographic were developed, including: 1. Early screening and diagnosis of GDM, and 2. Involvement of women with GDM and their significant others during pregnancy, intrapartum and postpartum management, in a culturally and socio-economically appropriate manner. Key conclusions The recommendations and infographic, once reviewed and pilot tested, may assist midwives managing GDM in Ghana, with support of health institution management. Implications for practice The study highlights the need for recommendations which can be used by midwives to manage GDM in Ghana. The recommendations are the first to be contextualized for the Ghanaian setting.
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Affiliation(s)
- Gwendolyn Patience Mensah
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Ghana
- Department of Nursing Science, Faculty of Health Sciences, Nelson Mandela University, Gqeberha (formerly Port Elizabeth), South Africa
| | - Dalena (R.M.) van Rooyen
- Faculty of Health Sciences, Nelson Mandela University, Gqeberha (formerly Port Elizabeth), South Africa
| | - Wilma ten Ham-Baloyi
- Faculty of Health Sciences, Nelson Mandela University, Gqeberha (formerly Port Elizabeth), South Africa
- Corresponding author.
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15
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Ghamri KA, Alsulami SS, Alotaibi LA, Salem IW, Tash RF, Yousof SM. Determinants of insulin therapy among women with gestational diabetes mellitus: A cross-sectional study. Niger J Clin Pract 2023; 26:417-423. [PMID: 37203105 DOI: 10.4103/njcp.njcp_447_22] [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: 05/20/2023]
Abstract
Background Gestational diabetes mellitus (GDM) is a common complication in pregnancy that occurs during the second half of pregnancy. In the majority of patients, medical nutritional therapy (MNT) alone is sufficient to achieve the glycemic goal. Aim To evaluate the clinical and biochemical factors that predict the need for insulin therapy in women with GDM. Materials and Methods Between March 2020 and November 2021, an analytic cross-sectional study was conducted on 127 women diagnosed with GDM at their final antenatal visit. Multivariate logistic regression was used to determine the variables associated with the likelihood of insulin requirement in patients with GDM. Results To achieve glycemic control, 56.7% of the study population required insulin treatment. Fasting glucose, pre-conceptional body mass index (BMI), parity, and third-trimester glycated hemoglobin levels were all higher in the insulin-treated group (P = 0.00, 0.01, 0.01, and 0.02), respectively. Fasting glucose level is the main determinant of insulin use in patients with GDM (odds ratio [OR]: 1.110; 95% confidence interval [CI]: 1.001-1.191; P = 0.004). Conclusions Fasting glucose level is the most important predictor of the need for insulin therapy.
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Affiliation(s)
- K A Ghamri
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - S S Alsulami
- Department of Internal Medicine, Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - L A Alotaibi
- Internal Medicine Department, King Abdulaziz Hospital, Endocrine and Diabetic Center, Jeddah, Saudi Arabia
| | - I W Salem
- Community Medicine Department, King Abdulaziz University, Rabigh, Saudi Arabia; Community Medicine Department, Al Azhar University, Cairo, Egypt
| | - R F Tash
- Anatomy and Embryology Department, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia; Anatomy and Embryology Department, Faculty of Medicine, Ain Shams University, Abassia, Cairo, Egypt
| | - S M Yousof
- Physiology Department, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia; Physiology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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16
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Lake AJ, Williams A, Neven ACH, Boyle JA, Dunbar JA, Hendrieckx C, Morrison M, O’Reilly SL, Teede H, Speight J. Barriers to and enablers of type 2 diabetes screening among women with prior gestational diabetes: A qualitative study applying the Theoretical Domains Framework. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1086186. [PMID: 36993822 PMCID: PMC10012118 DOI: 10.3389/fcdhc.2023.1086186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/12/2023] [Indexed: 03/02/2023]
Abstract
IntroductionWomen with previous gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes (T2D). Guidelines recommend postnatal diabetes screening (oral glucose tolerance test or HbA1c) typically 6-12 weeks after birth, with screening maintained at regular intervals thereafter. Despite this, around half of women are not screened, representing a critical missed opportunity for early identification of prediabetes or type 2 diabetes. While policy and practice-level recommendations are comprehensive, those at the personal-level primarily focus on increasing screening knowledge and risk perception, potentially missing other influential behavioral determinants. We aimed to identify modifiable, personal-level factors impacting postpartum type 2 diabetes screening among Australian women with prior gestational diabetes and recommend intervention functions and behavior change techniques to underpin intervention content.Research design and methodsSemi-structured interviews with participants recruited via Australia’s National Gestational Diabetes Register, using a guide based on the Theoretical Domains Framework (TDF). Using an inductive-deductive approach, we coded data to TDF domains. We used established criteria to identify ‘important’ domains which we then mapped to the Capability, Opportunity, Motivation–Behavior (COM-B) model.ResultsNineteen women participated: 34 ± 4 years, 19 ± 4 months postpartum, 63% Australian-born, 90% metropolitan, 58% screened for T2D according to guidelines. Eight TDF domains were identified: ‘knowledge’, ‘memory, attention, and decision-making processes’, ‘environmental context and resources’, ‘social influences’, ‘emotion’, ‘beliefs about consequences’, ‘social role and identity’, and ‘beliefs about capabilities’. Study strengths include a methodologically rigorous design; limitations include low recruitment and homogenous sample.ConclusionsThis study identified numerous modifiable barriers and enablers to postpartum T2D screening for women with prior GDM. By mapping to the COM-B, we identified intervention functions and behavior change techniques to underpin intervention content. These findings provide a valuable evidence base for developing messaging and interventions that target the behavioral determinants most likely to optimize T2D screening uptake among women with prior GDM.
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Affiliation(s)
- Amelia J. Lake
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioral Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- *Correspondence: Amelia J. Lake,
| | - Amelia Williams
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioral Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Adriana C. H. Neven
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Jacqueline A. Boyle
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
- Monash Department of Obstetrics and Gynecology, Monash Health, Clayton, VIC, Australia
| | - James A. Dunbar
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, VIC, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioral Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | | | - Sharleen L. O’Reilly
- School of Exercise & Nutrition Science, Deakin University, Burwood, VIC, Australia
- UCD Institute of Food and Health, College of Health and Agricultural Sciences, University College Dublin, Dublin, Ireland
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioral Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
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Khajeei D, Neufeld H, Donelle L, Meyer SB, Neiterman E, Ike NA, Li JZ. Maternal health literacy and health numeracy conceptualizations in public health: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3534-e3546. [PMID: 36039472 DOI: 10.1111/hsc.13981] [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: 04/19/2022] [Revised: 07/09/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
Despite unprecedented advancement in educational opportunities and access to information, maternal health literacy (MHL) and health numeracy (HN) skills remain low in North America. By enhancing MHL, the educated civic public-those who have the capacity, skills, and knowledge to apply prose and numerical health information-engages more proactively in public health practice. The purpose of this scoping review was to map the existing empirical evidence on MHL to work toward a better understanding of the practical implications for public health. We explored MHL and HN through the following research question: "How are maternal health literacy and health numeracy conceptualised in public health planning, implementation, and evaluation?" First, we employed a five-stage methodological framework for scoping reviews and used PRISMA-P to systematically identify eligible articles. Then, we used thematic analysis and an inductive approach guided by the research aims to identify themes related to how MHL and HN are conceptualised in empirical studies and developed an evidence table. Finally, two different reviewers coded articles using an inductive approach into six themes. We identified 1733 articles through a systematic search of five databases. After screening all the articles, 52 articles were included for thematic analysis. The final themes were: (i) sociocultural demographics; (ii) self-efficacy; (iii) communication; (iv) information seeking and operationalisation; (v) health status; and (vi) reasoning. The research evidence demonstrated limitations concerning the impact of sociocultural background on a mother's recognition of health problems and the extent of which patient-centred care is culturally and linguistically appropriate. The research evidence revealed an opportunity to address the sociocultural linguistic experience of mothers within public health practice. Our research team supports moving away from the biomedical model of evidence-based medicine and adopting evidence-based practice ensures healthcare providers develop a holistic understanding of the maternal health needs of socioculturally diverse mothers.
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Affiliation(s)
- Dahlia Khajeei
- Faculty of Health, School of Public Health Sciences (SPHS), University of Waterloo, Waterloo, Ontario, Canada
| | - Hannah Neufeld
- Faculty of Health, School of Public Health Sciences (SPHS), University of Waterloo, Waterloo, Ontario, Canada
| | - Lorie Donelle
- Faculty of Health, School of Public Health Sciences (SPHS), University of Waterloo, Waterloo, Ontario, Canada
| | - Samantha B Meyer
- Faculty of Health, School of Public Health Sciences (SPHS), University of Waterloo, Waterloo, Ontario, Canada
| | - Elena Neiterman
- Faculty of Health, School of Public Health Sciences (SPHS), University of Waterloo, Waterloo, Ontario, Canada
| | - Nnenna A Ike
- Faculty of Health, School of Public Health Sciences (SPHS), University of Waterloo, Waterloo, Ontario, Canada
| | - Janet Z Li
- Faculty of Health, School of Public Health Sciences (SPHS), University of Waterloo, Waterloo, Ontario, Canada
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Perceptions of Key Informant Health Professionals before implementing tighter glycaemic targets for women with gestational diabetes mellitus in New Zealand. PLoS One 2022; 17:e0271699. [PMID: 35960738 PMCID: PMC9374239 DOI: 10.1371/journal.pone.0271699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background Tighter glycaemic targets may be of benefit for women with GDM and their infants. Barrier and enabler identification prior to implementation of tighter glycaemic targets for women with GDM may support a successful transition. Methods A cross-sectional questionnaire survey was conducted among Key Informant Health Professionals in ten hospitals in New Zealand. The survey assessed what was currently working using less tight glycaemic targets; what barriers and enablers were considered likely when introducing tighter glycaemic targets and whether these perceptions differed by health professional groups. Results Sixty Key Health Informant Health Professionals completed the survey. When using the lower glycaemic targets, participants considered that women with GDM found the targets easy to use and that collaborative collegial support was effective. No significant barriers were identified. Perceived enablers identified prior to implementation of tighter targets included receiving collegial support (40, 67%), attending education sessions (38, 63%), use of pocket prompt cards (31, 52%), availability of wall charts (25, 42%) and glycaemic target reminder stickers (24, 40%). For health professionals referring into the Diabetes in Pregnancy Service effective communication (50, 83%) was considered important. Perceived barriers were confusion over glycaemic targets use (27 (45%), not being informed of the glycaemic target change (31, 52%), non-involvement with multidisciplinary decisions (29, 48%) and increased difficulty of blood glucose control for women (48, 80%). Overall, barriers and enablers between Health Professional groups did not differ. Discussion Key Informant Health Professionals reported effective communication as a key perceived enabler and that woman would find it more difficult to control their blood glucose concentrations. Education sessions, multidisciplinary engagement, wall charts and stickers were considered effective to overcome the perceived barriers. Further research is needed to assess if the barriers perceived were realised and if the perceived enablers supported the implementation of the tighter glycaemic targets effectively.
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Altemani AH, Alzaheb RA. The prevention of gestational diabetes mellitus (The role of lifestyle): a meta-analysis. Diabetol Metab Syndr 2022; 14:83. [PMID: 35706048 PMCID: PMC9199329 DOI: 10.1186/s13098-022-00854-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/05/2022] [Indexed: 11/11/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is the most common complication of pregnancy. The disease is on the rise worldwide with deleterious consequences on the fetus, mother, and children. The study aimed to review the role of lifestyle in the prevention of GDM. We searched PubMed, SCOPUS, Web of Science, Cochrane Library, EBSCO, and Google Scholar from the first published article up to December 2021; articles were eligible if they were controlled trials, prospective cohorts, and case-control. Out of 5559 articles retrieved, 66 full texts were screened, and 19 studies were included in the meta-analysis. (6 studies assessed the effects of diet, and 13 were on exercise). The dietary intervention showed significant positive effect on GDM, odd ratio = 0.69, 95% CI, 0.56-84, P-value for overall effect = 0.002. The DASH diet was better than Mediterranean Diet (odd ratio, 0.71, 95% CI, 68-74, P-value < 0.001). Regarding exercise, no significant prevention was evident on GDM, odd ratio, 0.77, 95% CI, 0.55-1.06, P-value = 0.11. However, a significant prevention of gestational diabetes was found when the exercise was mild-moderate (odd ratio = 0.65, 95% CI, 0.53-80, P < 0.0001) and started in the first trimester (odd ratio, 0.57, 95% CI, 0.43-0.75, P < 0.0001. No significant effect was found when the exercise was vigorous (odd ratio = 1.09, 95% CI, 0.50-2.38, P = 0.83) and started during the second trimester of pregnancy (odd ratio, 1.08, 95% CI, 0.65-1.80, P = 0.77. Diet and early mild-moderate exercise were effective in GDM prevention. Exercise during the second trimester and moderate-vigorous were not. Further studies assessing the type, duration, and frequency of physical activity are needed.
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Affiliation(s)
- Abdullah H Altemani
- Department of Family and Community Medicine, Faculty of Medicine, University of Tabuk, Tabuk, 71491, Saudi Arabia.
| | - Riyadh A Alzaheb
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia
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Montagnese S, Zarantonello L, Formentin C, Giusti G, Mangini C, Isherwood CM, Ferrari P, Paoli A, Mapelli D, Rizzuto R, Toppo S, Skene DJ, Vettor R, Costa R. A Circadian Hygiene Education Initiative Covering the Pre-pandemic and Pandemic Period Resulted in Earlier Get-Up Times in Italian University Students: An Ecological Study. Front Neurosci 2022; 16:848602. [PMID: 35495039 PMCID: PMC9047178 DOI: 10.3389/fnins.2022.848602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
The aims of the present study were to obtain sleep quality and sleep timing information in a group of university students and to evaluate the effects of a circadian hygiene education initiative. All students of the University of Padova (approximately 64,000) were contacted by e-mail (major campaigns in October 2019 and October 2020) and directed to an ad hoc website for collection of demographics and sleep quality/timing information. Participants (n = 5,740) received one of two sets of circadian hygiene advice (“A regular life” or “Bright days and dark nights”). Every month, they were then asked how easy it had been to comply and provided with the advice again. At any even month from joining, they completed the sleep quality/timing questionnaires again. Information on academic performance was obtained post hoc, together with representative samples of lecture (n = 5,972) and examination (n = 1,800) timings, plus lecture attendances (n = 25,302). Fifty-two percent of students had poor sleep quality, and 82% showed signs of social jetlag. Those who joined in October 2020, after several months of lockdown and distance learning, had better sleep quality, less social jetlag, and later sleep habits. Over approximately a year, the “Bright days and dark nights” advice resulted in significantly earlier get-up times compared with the “A regular life” advice. Similarly, it also resulted in a trend toward earlier midsleep (i.e., the midpoint, expressed as clock time, between sleep onset and sleep offset) and toward a decrease in the latency between wake-up and get-up time, with no impact on sleep duration. Significant changes in most sleep quality and sleep timing variables (i.e., fewer night awakenings, less social jetlag, and delayed sleep timing during lock-down) were observed in both advice groups over approximately a year, mostly in association with pandemic-related events characterizing 2020. Early chronotype students had better academic performances compared with their later chronotype counterparts. In a multivariate model, sleep quality, chronotype and study subject (science and technology, health and medical, or social and humanities) were independent predictors of academic performance. Taken together, these results underlie the importance of designing circadian-friendly university timetables.
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Affiliation(s)
- Sara Montagnese
- Department of Medicine, University of Padova, Padua, Italy
- *Correspondence: Sara Montagnese,
| | | | | | | | - Chiara Mangini
- Department of Medicine, University of Padova, Padua, Italy
| | - Cheryl M. Isherwood
- Chronobiology Section, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | | | - Antonio Paoli
- Department of Biomedical Sciences, University of Padova, Padua, Italy
| | - Daniela Mapelli
- Department of General Psychology, University of Padova, Padua, Italy
| | - Rosario Rizzuto
- Department of Biomedical Sciences, University of Padova, Padua, Italy
| | - Stefano Toppo
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Debra J. Skene
- Chronobiology Section, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Roberto Vettor
- Department of Medicine, University of Padova, Padua, Italy
| | - Rodolfo Costa
- Chronobiology Section, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
- Department of Biology, University of Padova, Padua, Italy
- Institute of Neuroscience, National Research Council (CNR), Padua, Italy
- Rodolfo Costa,
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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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22
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Adherence to Clinical Practice Guideline Recommendations in Women with Gestational Diabetes and Associations with Maternal and Infant Health—A Cohort Study. Nutrients 2022; 14:nu14061274. [PMID: 35334931 PMCID: PMC8949953 DOI: 10.3390/nu14061274] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 12/25/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is managed by dietary advice, but limited evidence exists about the impact of adherence on health. We assessed whether adherence to the New Zealand Ministry of Health dietary recommendations is associated with maternal and infant health in women with GDM. Data from 313 women with GDM were used. Adherence to food-related recommendations was scored from 0 (no adherence) to 10 (adhered to all recommendations) and analysed in tertile groups (high, moderate, low adherence). Adherence to visiting a dietitian and appropriate weight gain were assessed as yes or no. Chi-square, ANOVA, and odds ratios were used to compare groups. High dietary adherence compared to low adherence was associated with reduced oral hypoglycaemic and insulin use (OR = 0.55, CI = 0.30–1.00). Visiting a dietitian compared to not was associated with increased oral hypoglycaemic and insulin use (OR = 2.96, CI = 1.12–7.80), decreased odds of a large-for-gestational-age infant (OR = 0.32, CI = 0.14–0.73) and neonatal hyperbilirubinaemia (OR = 0.27, CI = 0.08–0.95). Greater than recommended compared with recommended weight gain was associated with increased oral hypoglycaemic and insulin use (OR = 2.51, CI = 1.26–5.01), while lower than recommended weight gain was associated with decreased postpartum haemorrhage (OR = 0.45, CI = 0.23–0.91) and increased breastfeeding (OR = 1.96, CI = 1.04–3.70). Adherence to dietary recommendations for women with GDM likely improves health outcomes.
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Blair RA, Horn CE, Dias JM, McDonnell ME, Seely EW. Development and Usability of a Text Messaging Program for Women With Gestational Diabetes: Mixed Methods Study. JMIR Hum Factors 2022; 9:e32815. [PMID: 35191851 PMCID: PMC8905478 DOI: 10.2196/32815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/29/2021] [Accepted: 12/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) affects 5%-10% of pregnancies and can lead to serious fetal and maternal complications. SMS text messaging is an effective way to improve diabetes management outside of pregnancy, but has not been well studied in GDM. Objective This study aimed to perform user experience testing and assess usability and acceptability of an SMS text messaging program (Text 4 Success) for women with GDM. Methods An automated 2-way texting program was developed. It included (1) reminders to check blood glucose levels, (2) positive feedback to user-reported glucose levels, (3) weekly educational messages, and (4) weekly motivational messages. For the user experience testing, women received simulated messages. For the usability study, women were enrolled in the program and received messages for 2 weeks. All women participated in semistructured interviews. For women in the usability study, data from glucose measuring devices were downloaded to assess adherence to self-monitoring of blood glucose (SMBG), measured as the percentage of recommended SMBG checks performed (a secondary outcome). Results Ten women participated in user experience testing. Suggestions for optimization included further customization of message timing and minimization of jargon, which were incorporated. Ten women participated in the usability study. All 10 would recommend the program to other women with GDM. Participants liked the immediate feedback to glucose values. Suggestions included further flexibility of messages related to mealtimes and the ability to aggregate blood glucose data into a table or graph. Overall, adherence to SMBG testing was high at baseline (222/238 recommended checks, 93%). In comparing the week prior to the trial with the 2 weeks during the trial, there was a small but statistically insignificant difference (P=.48) in the percentage of recommended SMBG performed (median 93% [25th-75th IQR 89%-100%] vs median 97% [25th-75th IQR 92%-100%]). Conclusions Overall, women with GDM would recommend the Text 4 Success in GDM program and think it is helpful for GDM self-management. The program was usable and acceptable. The program may be better suited to those who have low levels of adherence to SMBG at baseline or to women at time of their diagnosis of GDM. Adaptations to the program will be made based on user suggestions. Further study of SMS text messaging to improve SMBG in GDM is needed.
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Affiliation(s)
- Rachel A Blair
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Christine E Horn
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Jennifer M Dias
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Marie E McDonnell
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ellen W Seely
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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Ashley L, Kassim S, Kellar I, Kidd L, Mair F, Matthews M, Price M, Swinson D, Taylor J, Velikova G, Wadsley J. Identifying ways to improve diabetes management during cancer treatments (INDICATE): protocol for a qualitative interview study with patients and clinicians. BMJ Open 2022; 12:e060402. [PMID: 35193924 PMCID: PMC8867345 DOI: 10.1136/bmjopen-2021-060402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION A large and growing number of patients with cancer have comorbid diabetes. Cancer and its treatment can adversely impact glycaemic management and control, and there is accumulating evidence that suboptimal glycaemic control during cancer treatment is a contributory driver of worse cancer-related outcomes in patients with comorbid diabetes. Little research has sought to understand, from the perspective of patients and clinicians, how and why different aspects of cancer care and diabetes care can complicate or facilitate each other, which is key to informing interventions to improve diabetes management during cancer treatments. This study aims to identify and elucidate barriers and enablers to effective diabetes management and control during cancer treatments, and potential intervention targets and strategies to address and harness these, respectively. METHODS AND ANALYSIS Qualitative interviews will be conducted with people with diabetes and comorbid cancer (n=30-40) and a range of clinicians (n=30-40) involved in caring for this patient group (eg, oncologists, diabetologists, specialist nurses, general practitioners). Semistructured interviews will examine participants' experiences of and perspectives on diabetes management and control during cancer treatments. Data will be analysed using framework analysis. Data collection and analysis will be informed by the Theoretical Domains Framework, and related Theory and Techniques Tool and Behaviour Change Wheel, to facilitate examination of a comprehensive range of barriers and enablers and support identification of pertinent and feasible intervention approaches. Study dates: January 2021-January 2023. ETHICS AND DISSEMINATION The study has approval from National Health Service (NHS) West Midlands-Edgbaston Research Ethics Committee. Findings will be presented to lay, clinical, academic and NHS and charity service-provider audiences via dissemination of written summaries and presentations, and published in peer-reviewed journals. Findings will be used to inform development and implementation of clinical, health services and patient-management intervention strategies to optimise diabetes management and control during cancer treatments.
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Affiliation(s)
- Laura Ashley
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Saifuddin Kassim
- Leeds Centre for Diabetes and Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, UK
| | - Lisa Kidd
- Nursing & Healthcare, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Frances Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mike Matthews
- Patient and Public Involvement representative, Harrogate, UK
| | - Mollie Price
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Daniel Swinson
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Johanna Taylor
- Department of Health Sciences, University of York, York, UK
| | - Galina Velikova
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Jonathan Wadsley
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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25
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Liney T, Shah NM, Singh N. Recurrent gestational diabetes : Breaking the transgenerational cycle with lifestyle modification. Wien Klin Wochenschr 2022; 134:788-798. [PMID: 35147773 DOI: 10.1007/s00508-022-02004-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE This literature review is aimed at examining the benefits of lifestyle modifications in preventing recurrent gestational diabetes (GDM). Worldwide GDM affects approximately 16.2% of all pregnancies with significant maternal, fetal and neonatal complications. Almost two thirds of pregnant women with GDM will develop type 2 diabetes mellitus (T2DM) in the years following pregnancy. The proportion of women affected by GDM is on the rise and reflects increasing trends in T2DM as well as adult and childhood obesity. METHODS Using predefined subject headings, we searched for relevant articles from the PubMed, Scopus, and Cochrane databases. RESULTS For high-risk women lifestyle modifications, such as dietary and exercise changes, are the mainstay of treatment to reduce negative outcomes for both women and their pregnancies. This includes reducing the incidence of recurrent GDM and future T2DM by intervening during pregnancy and in the postnatal period. CONCLUSION This review provides an overview of the literature to date, discusses different targeted approaches and how these interventions can optimise their benefits, and where further research is required.
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Affiliation(s)
- Thomas Liney
- The Hillingdon Hospitals NHS Foundation Trust, Pield Heath Road, UB8 3NN, Uxbridge, UK
| | - Nishel M Shah
- Imperial College London, Academic Department of Obstetrics & Gynaecology, Level 3, Chelsea and Westminster Hospital, 369 Fulham Road, SW10 9NH, London, UK
| | - Natasha Singh
- Imperial College London, Academic Department of Obstetrics & Gynaecology, Level 3, Chelsea and Westminster Hospital, 369 Fulham Road, SW10 9NH, London, UK.
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26
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Duan B, Liu Z, Liu W, Gou B. Views and needs of people who at high-risk of gestational diabetes mellitus for the development of mobile health applications: A descriptive qualitative research (Preprint). JMIR Form Res 2022; 6:e36392. [PMID: 35802414 PMCID: PMC9308070 DOI: 10.2196/36392] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background Early prevention of gestational diabetes mellitus (GDM) can reduce the incidence of not only GDM, but also adverse perinatal pregnancy outcomes. Moreover, it is of great significance to prevent or reduce the occurrence of type 2 diabetes. Mobile health (mHealth) apps can help pregnant women effectively prevent GDM by providing risk prediction, lifestyle support, peer support, professional support, and other functions. Before designing mHealth apps, developers must understand the views and needs of pregnant women, and closely combine users’ needs to develop app functions, in order to better improve user experience and increase the usage rate of these apps in the future. Objective The objective of this study was to understand the views of the high-risk population of gestational diabetes mellitus on the development of mobile health apps and the demand for app functions, so as to provide a basis for the development of gestational diabetes mellitus prevention apps. Methods Fifteen pregnant women with at least one risk factor for gestational diabetes were recruited from July to September 2021, and were interviewed via a semistructured interview using the purpose sampling method. The transcribed data were analyzed by the traditional content analysis method, and themes were extracted. Results Respondents wanted to develop user-friendly and fully functional mobile apps for the prevention of gestational diabetes mellitus. Pregnant women's requirements for app function development include: personalized customization, accurate information support, interactive design, practical tool support, visual presentation, convenient professional support, peer support, reasonable reminder function, appropriate maternal and infant auxiliary function, and differentiated incentive function.These function settings can encourage pregnant women to improve or maintain healthy living habits during their use of the app Conclusions This study discusses the functional requirements of target users for gestational diabetes mellitus prevention apps, which can provide reference for the development of future applications.
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Affiliation(s)
- Beibei Duan
- School of Nursing, Capital Medical University, Beijing, China
| | - Zhe Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Weiwei Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Baohua Gou
- Beijing Youyi Hospital, Capital Medical University, Beijing, China
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27
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Hanks AJ, Hume C, Lim S, Grieger JA. The Perspectives of Diabetes Educators and Dietitians on Diet and Lifestyle Management for Gestational Diabetes Mellitus: A Qualitative Study. J Diabetes Res 2022; 2022:3542375. [PMID: 35782628 PMCID: PMC9242803 DOI: 10.1155/2022/3542375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/13/2022] [Accepted: 06/13/2022] [Indexed: 12/31/2022] Open
Abstract
This study explores the knowledge and practice of diabetes educators and dietitians on diet and lifestyle management in women with gestational diabetes mellitus (GDM). Diabetes educators and dietitians were recruited from three maternity hospitals in Adelaide (Australia), through snowball and purposive sampling. Thirteen semistructured interviews were conducted, audio recorded, transcribed verbatim, and analysed for codes and themes. Four themes emerged: guidelines and resources, dietary intervention, management delivery, and communication. Diabetes educators and dietitians demonstrated consistent knowledge of nutritional management for GDM and uniform delivery methods. However, a lack of culturally diverse resources was highlighted, along with a lack of continuity of care across the multidisciplinary team. Barriers towards uptake of dietary intervention were reflected by diabetes educators and dietitians as women showing signs of guilt and stress and disengaging from the service. Further exploration on the knowledge and practice of diabetes educators and dietitians for GDM to best inform implementation strategies for knowledge translation of nutritional management is needed. The indication of language and cultural barriers and resources highlight an ongoing key priority area to support the care of women of ethnic minorities.
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Affiliation(s)
- Amber J. Hanks
- School of Public Health, University of Adelaide, Adelaide 5000, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Clare Hume
- School of Public Health, University of Adelaide, Adelaide 5000, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, Clayton 3168, Australia
| | - Jessica A. Grieger
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia
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28
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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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Chen Y, Qiu C, Chen J, Li L, Xu J, Sheng Z. Effect of the internet combined with exercise-based individualized nursing intervention in patients with gestational diabetes mellitus. Diabetol Metab Syndr 2021; 13:125. [PMID: 34717730 PMCID: PMC8557529 DOI: 10.1186/s13098-021-00738-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/14/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is the most frequent medical complication of pregnancy. This condition is manifested by glucose intolerance resulting in hyperglycemia of variable severity during pregnancy. One of the most important clinical tools for efficiently regulating maternal blood glucose is strictly monitoring blood glucose levels. However, due to a lack of appropriate intervention tools, managing the occurrence of GDM is still unfeasible. This study aimed to determine clinical efficacy of the internet combined with exercise-based individualized nursing intervention in patients with gestational diabetes mellitus (GDM). METHODS In total, 139 patients with GDM were divided into two groups, with 79 patients in the observation group (internet combined with exercise-based individualized nursing intervention) and 60 patients in the control group (routine nursing intervention only). The two groups were given specified nursing intervention for 8 weeks and then compared for changes in their blood glucose, blood lipids, blood pressure, insulin resistance (IR), and rate of adverse pregnancy outcomes. Additionally, the psychological state was analyzed, and their nursing satisfaction with the care from nurses that they received was investigated before and after the nursing intervention. RESULTS Compared with the control group, the following indices of the observation group were lowered: blood glucose-related indices (FBG and 2 h PG), blood lipids and blood pressure associated indices (TG, TC, and HbA1c, DBP, SBP, and MAP), and IR-related indices (FINS, 2 h INS, and HOMA -IR) (all P < 0.05). The observation group also showed a lower rate of adverse pregnancy outcomes than the control group (7.59% vs. 20.00%; P < 0.05). In addition, SAS and SDS scores of the observation group were both lower than the control group (P < 0.05). Accordingly, the nursing satisfaction score also displayed that the observation group (93.67%) had a higher satisfaction outcome than the control group (76.67%; P < 0.05). CONCLUSIONS Internet combined with exercise-based individualized nursing intervention in GDM patients can effectively improve their blood glucose, IR, and psychological status, thus significantly improving their pregnancy outcomes and mental condition.
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Affiliation(s)
- Yaer Chen
- Department of Obstetrics, Affiliated Hospital of Ningbo University School of Medicine, Ningbo, 315000, Zhejiang, China
| | - Chunbo Qiu
- Department of Obstetrics, Affiliated Hospital of Ningbo University School of Medicine, Ningbo, 315000, Zhejiang, China
| | - Jie Chen
- Department of Obstetrics, Affiliated Hospital of Ningbo University School of Medicine, Ningbo, 315000, Zhejiang, China
| | - Lu Li
- Department of Obstetrics, Affiliated Hospital of Ningbo University School of Medicine, Ningbo, 315000, Zhejiang, China
| | - Jichao Xu
- Department of Obstetrics, Affiliated Hospital of Ningbo University School of Medicine, Ningbo, 315000, Zhejiang, China
| | - Zhiren Sheng
- Department of Nursing, Affiliated Hospital of Ningbo University School of Medicine, No. 247, Renmin Road, Ningbo, 315000, Zhejiang, China.
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Probiotic Supplements Improve Blood Glucose and Insulin Resistance/Sensitivity among Healthy and GDM Pregnant Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:9830200. [PMID: 34603479 PMCID: PMC8481047 DOI: 10.1155/2021/9830200] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/27/2021] [Indexed: 12/11/2022]
Abstract
Background Probiotic supplements may be seen as a promising way to improve glucose metabolism. This study aimed to evaluate the effects of probiotic supplements on blood glucose, insulin resistance/sensitivity, and prevention of gestational diabetes mellitus (GDM) among pregnant women. Methods Eleven electronic databases were searched from inception to May 2020. Two authors independently identified randomized controlled trials (RCTs), assessed the eligibility and quality of the included studies, and then extracted data. The primary outcomes were fasting plasma glucose (FPG), 1 h and 2 h plasma glucose after 75 g oral glucose tolerance test (OGTT), HbA1c, fasting plasma insulin, insulin resistance, and insulin sensitivity. Fixed and random effect models were used to pool the results. Results A total of 20 RCTs involving 2972 participants were included according to the inclusion and exclusion criteria. The pooled results of this research showed that probiotic supplements could reduce the level of FPG (mean difference (MD) = −0.11; 95% CI = −0.15 to −0.04; P=0.0007), serum insulin (MD = −1.68; 95% CI = −2.44 to −0.92; P < 0.00001), insulin resistance (MD = −0.36; 95% CI = −0.53 to −0.20; P < 0.00001), and insulin sensitivity (MD = −21.80; 95% CI = −31.92 to −11.67; P < 0.00001). Regarding the subgroup analysis of different pregnant women, the effects of probiotics on FPG, insulin, and insulin resistance were more obvious among GDM and healthy women than among overweight/obese women. Furthermore, the differences were not significant in HbA1c (MD = −0.05; 95% CI = −0.12 to 0.03; P=0.23), 1 h OGTT (MD = −0.07; 95% CI = −0.25 to 0.10; P=0.42), and 2 h OGTT (MD = −0.03; 95% CI = −0.17 to 0.12; P=0.72). Conclusion This review found that probiotic supplements had certain functions to reduce the level of FPG and improve insulin, insulin resistance, and insulin sensitivity, especially for GDM and healthy pregnant women.
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Garsia K, MacMillan F, Dune T, Simmons D. The role of the pharmacist in contraception and pre-pregnancy management for women with diabetes: a study of patient and pharmacist perspectives. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmab019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objectives
Women with diabetes are at increased risk of adverse pregnancy outcomes compared to women with gestational diabetes (GDM) or no diabetes. Pregnancy outcomes are improved by specialist pre-pregnancy care. We aimed to explore pharmacists’ and women with diabetes’ perceptions of the roles and barriers to pharmacist participation in a diabetes contraception and pre-pregnancy program in South-Western Sydney (SWS).
Methods
The Diabetes Contraception and Pre-pregnancy Program (DCAPP) aims to reduce adverse pregnancy outcomes among women with diabetes. This includes awareness raising among, and through, pharmacists. Surveys to explore pharmacists’ roles in contraception and pre-pregnancy management (CPPM) were completed by SWS pharmacists and women with diabetes from diabetes clinics aged 18–50 years. Survey themes were then discussed in interviews and focus groups with pharmacists across Australia. Thematic analysis of transcripts was undertaken.
Key findings
Pharmacists were seen to have a role in diabetes health promotion, information distribution and referral to pre-pregnancy clinics. Pharmacists and women recognised the need for increased knowledge and educational materials about CPPM and effective awareness and coordination of CPPM services. Some pharmacists recognised deficits in their knowledge regarding diabetes in pregnancy, including CPPM and differences to GDM. Barriers to pharmacists’ involvement in CPPM included difficulty identifying applicable women and reluctance to initiate pregnancy planning and contraception conversations, often due to language and cultural barriers.
Conclusions
Pharmacists and women with diabetes see an important role for pharmacists in CPPM. Co-designed diabetes training for pharmacists and increased communication about DCAPP were seen important for ongoing implementation.
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Affiliation(s)
- Kathryn Garsia
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Freya MacMillan
- School of Health Sciences & Diabetes Obesity and Metabolism Translation Unit, Western Sydney University, Campbelltown, NSW, Australia
- Diabetes Obesity and Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW, Australia
| | - Tinashe Dune
- School of Health Sciences & Diabetes Obesity and Metabolism Translation Unit, Western Sydney University, Campbelltown, NSW, Australia
- Diabetes Obesity and Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Diabetes Obesity and Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW, Australia
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Jackson J, Leziak K, Niznik CM, Yee LM. Health Care Providers' Utilization of and Perspectives on Mobile Health Technology for Diabetes and Pregnancy Support. Diabetes Spectr 2021; 34:257-267. [PMID: 34511852 PMCID: PMC8387606 DOI: 10.2337/ds20-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Mobile health (mHealth) technology can be an effective tool to deliver behavioral interventions to improve health outcomes for individuals with diabetes. However, there is limited evidence on mHealth for pregnant women managing diabetes or for the role of health care providers (HCPs) in delivering mHealth tools. To prepare for the development of a pregnancy-specific mHealth intervention for diabetes, we sought to understand HCPs' acceptance, utilization, and design recommendations for how mHealth technology can best be used to support the management of diabetes during pregnancy. METHODS Focus groups and individual interviews were conducted with clinical HCPs (obstetricians, nurses, diabetes educators, dietitians, and lactation counselors) who care for low-income pregnant women with diabetes. Data were analyzed using the constant comparative method. RESULTS Participants (n = 29) generated five themes and 14 subthemes. Knowledge and acceptance themes included utilization of mobile resources and barriers to HCPs' adoption. Knowledge of popular pregnancy applications (apps) dominated, while familiarity with and use of diabetes apps varied by profession and proximity to continued education. Technology adoption barriers included lack of credibility, dependence on Internet resources, and reliance on knowledge networks. Design themes addressed user-centered design, responsive and practical education, and clinical integration. Clinicians recommended patient-participatory design, customizable features, data-tracking features, motivational feedback, and bidirectional communication capabilities. CONCLUSION Although HCPs strongly embraced mHealth tools as an adjunct to obstetric care for women with diabetes, they also expressed limited knowledge and apprehension about patient engagement. HCP recommendations and concerns must critically inform the development of meaningful tools for this population.
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Sociodemographic Factors Associated with Adherence to Dietary Guidelines in Women with Gestational Diabetes: A Cohort Study. Nutrients 2021; 13:nu13061884. [PMID: 34072685 PMCID: PMC8228016 DOI: 10.3390/nu13061884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 12/16/2022] Open
Abstract
Dietary advice is the cornerstone of care for women with gestational diabetes mellitus (GDM). However, adherence to this advice is variable. We aimed to identify the proportion of women with GDM who adhere to the New Zealand nutrition guideline recommendations and assess the sociodemographic factors linked to dietary adherence. We assessed dietary intake at 36 weeks’ gestation in a cohort of 313 women with GDM and compared this with the dietary recommendations for the management of GDM. Associations between maternal characteristics and dietary adherence were assessed using ANOVA, chi square, logistic regression, and linear regression tests. Women with GDM had an average adherence score of 6.17 out of 10 to dietary recommendations, but no one adhered to all the recommendations. Adherence to recommendations was lowest for saturated fat, and wholegrain breads and cereals. While 85% visited a dietitian, only 28% of women achieved their recommended weight gain. Maternal factors associated with lower dietary adherence were primiparity, no previous history of GDM, being underweight, and smoking. Adherence to the dietary recommendations by women with GDM in New Zealand for the management could be improved. Further research is needed to identify ways for women with GDM to improve their dietary adherence.
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Birch EM, Leziak K, Jackson J, Dahl E, Niznik CM, Yee LM. What Are Patients Watching? A Quality and Content Evaluation of YouTube Videos About Gestational Diabetes. (Preprint). JMIR Diabetes 2021; 7:e30156. [PMID: 35389355 PMCID: PMC9030909 DOI: 10.2196/30156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/17/2021] [Accepted: 01/23/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People with gestational diabetes have enhanced learning requirements during pregnancy, and management of their disease often requires the translation of health information into new health behavior changes. Seeking information from the internet to augment learning from health professionals is becoming more common during pregnancy. YouTube is a popular free and accessible web-based resource, which may be particularly useful for individuals with low health literacy or other barriers to receiving high-quality health care; however, the quality and content of YouTube videos varies, and little is known about those covering gestational diabetes. OBJECTIVE We aimed to systematically evaluate the quality, content, and reliability of YouTube videos about gestational diabetes. METHODS A systematic search of YouTube videos was conducted over the course of 1 week in April 2020 using the following keywords: "gestational diabetes," "gestational diabetes management," "gestational diabetes treatment," and "pregnancy and diabetes." The search results were displayed by relevance, replicating a default YouTube search attempt. The first 60 results from each keyword were reviewed (n=240). Exclusion criteria were videos unrelated to gestational diabetes, videos not in English, and those for which the full video was not available at the time of review. For each unique video, a gestational diabetes content score was used to rate video comprehensiveness and accuracy, and the DISCERN instrument, a validated metric to assess consumer health information, was used to evaluate the reliability of information presented. Videos were further categorized by quality: videos with DISCERN scores lower than 3 (out of 5) or a content score less than 4 (out of 7) were categorized as low quality, and all others were designated high quality. We performed descriptive analysis and compared video characteristics by source and quality rating. RESULTS For 115 unique videos, the mean content score (out of 7) was 3.5 (SD 2.0) , and the mean DISCERN score (out of 5) was 2.7 (SD 0.7), representing low to moderate information comprehensiveness and reliability respectively. Video sources were categorized as personal vlog (12/115, 10.4%), web-based education (37/115, 32.2%), medical (52/115, 45.2%), business or company (13/115, 11.3%), and media clip (1/115, 0.9%). DISCERN and content scores trended higher among medical and web-based education videos. The majority of videos (n=88) were categorized as low quality, while 27 videos were categorized as high quality. Video duration was longer for high-quality videos (P<.001); high- and low-quality videos otherwise had similar views and viewer interaction numbers. CONCLUSIONS Although high-quality videos about gestational diabetes exist, reliability, accuracy, and comprehensiveness were low overall, and higher quality was not associated with increased viewer interaction. It is important to acknowledge the limitations of this platform and to assist patients in accessing high quality content and differentiating the quality of information sources.
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Affiliation(s)
- Eleanor M Birch
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Karolina Leziak
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jenise Jackson
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Emma Dahl
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Charlotte M Niznik
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Al Hashmi I. Gestational diabetes and determinants of adherence to healthy behaviors. Minerva Obstet Gynecol 2021; 74:146-154. [PMID: 33876902 DOI: 10.23736/s2724-606x.21.04754-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Previous studies on (GDM) focused on finding new strategies to decrease the incidence of its complications; however, there is insufficient evidence that investigate the influencing factors of adherence to healthy behaviors. This study examined the influencing factors of adherence to healthy behaviors among pregnant women with gestational diabetes (GDM). METHODS Descriptive cross-sectional design was used among pregnant women with gestational diabetes. The study participants completed study instruments twice (pre-test & post-test), with a four-weeks gap. The measurement scales included summary of diabetes self-care activities measure (SDSCA), diabetes management self-efficacy scales (DMSES) and open-ended questions to assess barriers and motivators of adherence. The analytical tool was multiple linear regression. RESULTS The results from multiple regression indicated that 20.0 % of the total variation in the adherence to healthy behaviors was explained by women's perceived self-efficacy and the overall relationship was significant [F (1, 88) = 23.60, p < .000]. From the demographic variables, only, the gestational age at delivery was found to be a significant predictor of adherence to healthy behaviors (t= -3.1, p< .05), adjusted Rsquare=15.6. Physical limitation and time constraints (40%) were the most reported barriers for adherence. Participants' concern of GDM-related complications (94.4%) and family moral support (52.2%) were the main identified motivators for adherence. CONCLUSIONS The importance of assessing determinants, barriers and motivators of adherence to healthy behaviors should be considered before planning any antenatal health promotion interventions designed for women with GDM. The study findings have implications for research, practice, policy advisors and public health. For practice, maternal nurses should consider the identified barriers in this study in any health education intervention and provide solutions and resources to the pregnant women to overcome these barriers. Policy advisors need to take into considerations providing pregnant women with flexible working hours that could encourage them maintaining healthy lifestyle behaviors during the pregnancy period. Researchers interested in GDM should examine in the upcoming studies different self-efficacy enhancing strategies among pregnant women with GDM.
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Affiliation(s)
- Iman Al Hashmi
- Maternal and Child Health Department, College of Nursing, Sultan Qaboos University, Muscat, Oman -
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Pirotta S, Joham A, Grieger JA, Tay CT, Bahri-Khomami M, Lujan M, Lim SS, Moran LJ. Obesity and the Risk of Infertility, Gestational Diabetes, and Type 2 Diabetes in Polycystic Ovary Syndrome. Semin Reprod Med 2021; 38:342-351. [PMID: 33873233 DOI: 10.1055/s-0041-1726866] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This review describes the relationship between obesity and the most common reproductive (infertility) and metabolic (gestational diabetes mellitus [GDM] and type 2 diabetes mellitus [T2DM]) consequences in polycystic ovary syndrome (PCOS). It also describes the vital role of lifestyle management for PCOS. PCOS is a heterogeneous endocrine disorder common in reproductive-age women. Consensus on the exact etiological mechanisms of PCOS is unreached. Overweight or obesity is present in at least 60% of the PCOS population, but the condition occurs irrespective of BMI, with excess BMI increasing both the prevalence and severity of clinical features. Use of lifestyle therapies (nutrition, physical activity, and/or behavioral) for the prevention and management of excess weight gain, infertility, GDM, and T2DM is a vital component of best-practice PCOS care. Lifestyle management is recommended for all women with PCOS as the first-line treatment with or without medications. Due to a lack of high-quality trials demonstrating the efficacy of specific lifestyle approaches, PCOS lifestyle recommendations are as those for the general population. This review summarizes current knowledge relating to obesity and its impact on fertility, GDM, and T2DM. It also summarizes the lifestyle recommendations to best manage these conditions in women with PCOS and obesity.
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Affiliation(s)
- Stephanie Pirotta
- Health and Social Care Unit, SPHPM, Monash University, Victoria, Australia
| | - Anju Joham
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia.,Department of Diabetes and Vascular Medicine, Monash Health, Victoria, Australia
| | - Jessica A Grieger
- Adelaide Medical School, University of Adelaide, South Australia, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Chau Tien Tay
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
| | - Mahnaz Bahri-Khomami
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
| | - Marla Lujan
- Division of Nutritional Sciences, Cornell University, New York
| | - Siew S Lim
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
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The association between gestational diabetes and ASD and ADHD: a systematic review and meta-analysis. Sci Rep 2021; 11:5136. [PMID: 33664319 PMCID: PMC7933135 DOI: 10.1038/s41598-021-84573-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 01/28/2021] [Indexed: 12/27/2022] Open
Abstract
There is growing evidence for a role of maternal diabetes in the pathogenesis of neurodevelopmental disorders. However, the specific association between gestational diabetes (GDM), as opposed to pre-gestational diabetes, has been poorly isolated. Thus the aim was to systematically review and meta-analyse literature pertaining to prevalence and risk for two neurodevelopmental disorders: autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), when exposed to GDM. PubMed, Cochrane Library, EMBASE, PsycINFO and CINAHL were systematically searched for eligible literature, with forward and backward citation tracking. Screening for eligibility, risk of bias assessment and data extraction were performed by two independent reviewers. 18 studies measuring ASD and 15 measuring ADHD met inclusion criteria. On meta-analysis there was an increased risk of ASD (OR 1.42; 95% CI 1.22, 1.65) but not ADHD (OR 1.01; 95% CI 0.79, 1.28). We discuss potential mechanisms for these differing risks. Greater understanding of risk factors, including GDM, for these neurodevelopmental disorders and potential mechanisms may help inform strategies aimed at prevention of exposure to these adversities during pregnancy.
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Helmersen M, Sørensen M, Lukasse M, Laine HK, Garnweidner-Holme L. Women's experience with receiving advice on diet and Self-Monitoring of blood glucose for gestational diabetes mellitus: a qualitative study. Scand J Prim Health Care 2021; 39:44-50. [PMID: 33555201 PMCID: PMC7971282 DOI: 10.1080/02813432.2021.1882077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE We aimed to explore how women with gestational diabetes mellitus (GDM) experience advice about diet and self-monitoring of blood glucose received in primary health care (PHC) and secondary health care (SHC) with a focus on how women perceived the care coordination and collaboration between healthcare professionals. DESIGN, SETTING AND SUBJECTS Individual interviews were conducted with 12 pregnant women diagnosed with GDM. Six women had immigrant backgrounds, and six were ethnic Norwegian. Women received GDM care in the area of Oslo, Norway. Interviews were analysed using thematic analysis. RESULTS Women described feeling shocked when they were diagnosed with GDM and feeling an immediate need for information about the consequences and management of GDM. Most of the women felt that their general practitioner (GP) had too little knowledge about GDM. Women with an immigrant background felt that the PHC midwives provided them with sufficient dietary advice related to GDM. Ethnic Norwegian women appreciated receiving more individually tailored dietary advice in SHC. Self-monitoring of blood glucose influenced women's daily lives; however, they perceived the training in PHC and SHC as adequate. The women experienced poor collaboration between healthcare professionals in PHC and SHC, which implied that they sometimes had to initiate follow-up steps in their GDM care by themselves. CONCLUSIONS Ideally, women diagnosed with GDM should meet healthcare professionals with sufficient knowledge about GDM as soon as possible after being diagnosed. The collaboration between healthcare professionals involved in the care of women with GDM should be improved to avoid having women feel that they need to coordinate their own care.KEY POINTSCurrent awareness•The management of gestational diabetes mellitus requires appropriate follow-up by healthcare professionalsMain statements•Pregnant women's need for information about the consequences and management of gestational diabetes mellitus was highest immediately after diagnosis•Women perceived that they received more individually tailored information about diet and self-monitoring of blood glucose in secondary health care compared to primary health care•Women felt that general practitioners had insufficient knowledge about gestational diabetes mellitus•Based on our results, care coordination and collaboration between healthcare professionals involved in the care of women with gestational diabetes mellitus should be improved.
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Affiliation(s)
- Maria Helmersen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Monica Sørensen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Mirjam Lukasse
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Faculty of Health and Social Sciences, Centre for Women’s, Family and Child Health, University of South-Eastern Norway, Kongsberg, Norway
| | - Hely Katariina Laine
- Department of Obstetrics, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lisa Garnweidner-Holme
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- CONTACT Lisa Garnweidner-Holme Department of Nursing and Health Promotion, Oslo Metropolitan University, St Olavs Plass, PO Box 4, Oslo, 0310, Norway
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Guo J, Long Q, Li J, Wang X, Li Y, Jiang S, Sun M, Wiley J, Chen JL. Barriers and facilitators of self-monitoring of blood glucose engagement among women with gestational diabetes mellitus in China: A mixed-methods study. Midwifery 2020; 90:102797. [PMID: 32755742 DOI: 10.1016/j.midw.2020.102797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 07/06/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Self-monitoring of blood glucose (SMBG) is a crucial tool for maintaining glycemic control in women with gestational diabetes mellitus (GDM). However, to date, little is known about the current status of SMBG engagement among women with GDM in China. OBJECTIVE To describe the current status of SMBG engagement among women with GDM in China and identify its barriers and facilitators. DESIGN AND SETTING A mixed-methods design was conducted, comprising a cross-sectional survey and semi-structured interviews. The research data were collected in two tertiary hospitals in Hunan province, China. PARTICIPANTS A total of 323 women with GDM completed the survey from March 2018 to October 2018, and 11 of them participated in the interviews. FINDING In total, 35.6% of the participants actively engaged in SMBG. The participants who had an advanced maternal age (95% CI 0.253-0.947), did not own glucose meters (95% CI 0.054-0.364), did not receive SMBG-related information from health professionals (95% CI 0.232-.987), or received less SMBG information in general (95% CI 0.137-0.52) were less likely to engage in SMBG. Insufficient SMBG information and low awareness of SMBG were also summarized as the main barriers in the interview findings. Facilitators of SMBG engagement included SMBG-related social support (95% CI 1.573-6.135) and health concerns related to themselves and the unborn infant. CONCLUSION About one-third of Chinese women with GDM engaged in SMBG. An accurate and complete description of how SMBG should be performed is needed from health professionals. Strategies to obtain more SMBG-related social support and a greater emphasis on health concerns are recommended to increase SMBG engagement among women with GDM in China.
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Affiliation(s)
- Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, PR China.
| | - Qing Long
- Xiangya School of Nursing, Central South University, Changsha, Hunan, PR China.
| | - Junrong Li
- Second Xiangya Hospital,Central South University, Changsha, Hunan, PR China.
| | - Xin Wang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, PR China.
| | - Yixuan Li
- Third Xiangya Hospital, Central South University, Changsha, Hunan, PR China.
| | - Shan Jiang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, PR China.
| | - Mei Sun
- Xiangya School of Nursing, Central South University, Changsha, Hunan, PR China; Hunan Women's Research Association, Changsha, Hunan, 410013, PR China.
| | - James Wiley
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
| | - Jyu-Lin Chen
- School of Nursing, University of California, San Francisco, CA, USA.
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Hewage S, Audimulam J, Sullivan E, Chi C, Yew TW, Yoong J. Barriers to Gestational Diabetes Management and Preferred Interventions for Women With Gestational Diabetes in Singapore: Mixed Methods Study. JMIR Form Res 2020; 4:e14486. [PMID: 32602845 PMCID: PMC7367517 DOI: 10.2196/14486] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 02/04/2020] [Accepted: 02/21/2020] [Indexed: 12/19/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is associated with risks for both the mother and child. The escalated prevalence of GDM because of obesity and changes in screening criteria demands for greater health care needs than before. Objective This study aimed to understand the perception of patients and health care providers of the barriers to GDM management and preferred interventions to manage GDM in an Asian setting. Methods This mixed methods study used a convergent parallel design. Survey data were collected from 216 women with GDM, and semistructured interviews were conducted with 15 women and with 8 health care providers treating patients with GDM. Participants were recruited from 2 specialized GDM clinics at the National University Hospital, Singapore. Results The patients were predominantly Chinese (102/214, 47.6%), employed (201/272, 73.9%), with higher education (150/216, 69.4%) and prenatal attendance at a private clinic (138/214, 64.2%), already on diet control (210/214, 98.1%), and receiving support and information from the GDM clinic (194/215, 90.2%) and web-based sources (131/215, 60.9%). In particular, working women reported barriers to GDM management, including the lack of reminders for blood glucose monitoring, diet control, and insufficient time for exercise. Most women preferred getting such support directly from health care providers, whether at the GDM clinic (174/215, 80.9%) or elsewhere (116/215, 53.9%). Smartphone apps were the preferred means of additional intervention. Desirable intervention features identified by patients included more information on GDM, diet and exercise options, reminders for blood glucose testing, a platform to record blood glucose readings and illustrate or understand trends, and a means to communicate with care providers. Conclusions A GDM-focused smartphone app that is able to integrate testing, education, and communication may be a feasible and acceptable intervention to provide support to women with GDM, particularly for working women.
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Affiliation(s)
- Sumali Hewage
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jananie Audimulam
- Integrated Health Promotion Unit, Ministry of Health Transformation Office, Singapore, Singapore
| | - Emily Sullivan
- Family Planning 2020, United Nations Foundation, Washington, WA, United States
| | - Claudia Chi
- Department of Obstetrics and Gynecology, National University Hospital, Singapore, Singapore
| | - Tong Wei Yew
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Joanne Yoong
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States
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Gunn C, Bernstein J, Bokhour B, McCloskey L. Narratives of Gestational Diabetes Provide a Lens to Tailor Postpartum Prevention and Monitoring Counseling. J Midwifery Womens Health 2020; 65:681-687. [PMID: 32568461 DOI: 10.1111/jmwh.13122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 03/02/2020] [Accepted: 03/10/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Women with gestational diabetes mellitus (GDM) have a marked increased risk of early onset type 2 diabetes, but less than half initiate postpartum glucose testing or connect with a primary care provider for continued follow-up after giving birth. This study analyzed women's narratives about their GDM-affected pregnancies to (1) identify different patterns (narrative archetypes) that capture the GDM experience; (2) explore how these patterns relate to awareness of ongoing risk after pregnancy and affect participation in self-care, monitoring, and preventive health care going forward; and (3) explore the use of identified patterns to tailor conversations with patients during prenatal and postpartum care to their actual perceptions and concerns about future risk. METHODS Open-ended interviews elicited women's experiences and perspectives about GDM and its management. A narrative analysis first identified segments of text related to risk and behaviors and then applied Frank's narrative archetypes (restitution, chaos, quest) as an interpretive lens. RESULTS Interviews were completed in English (n = 15), Spanish (n = 7), and Haitian Creole (n = 7). We found distinct patterns: stories of restitution (n = 13), quest (n = 4), chaos (n = 4), and mixed narratives (n = 7). Using these archetypes, we found differences in how women respond to challenges related to disease complexity, treatment, and future risks. These patterns led to marked differences in the steps women took to prevent early onset type 2 diabetes. DISCUSSION Frank's narrative types provided insight into women's responses to clinical protocols, health care advice, and subsequent prevention actions. A restitution pattern may result in premature closure and lack of awareness of risk. Similarly, a chaos pattern may contribute to a sense of helplessness to implement follow-up recommendations, despite risk awareness. Understanding these patterns can help clinicians tailor individualized support as women transition from GDM with its focus on a healthy fetus and newborn to preventive self-care to protect their health.
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Affiliation(s)
- Christine Gunn
- Department of Medicine, Section of General Internal Medicine, Women's Health Unit, Boston University School of Medicine, Boston, Massachusetts.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Judith Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.,Department of Emergency Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Barbara Bokhour
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts.,Center for Health Quality, Outcomes and Economic Research at the Bedford Veterans Affairs, Boston, Massachusetts
| | - Lois McCloskey
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
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McGowan LJ, Powell R, French DP. How can use of the Theoretical Domains Framework be optimized in qualitative research? A rapid systematic review. Br J Health Psychol 2020; 25:677-694. [DOI: 10.1111/bjhp.12437] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/09/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Laura J. McGowan
- Manchester Centre for Health Psychology School of Health Sciences The University of Manchester UK
- Population Health Sciences Institute Newcastle University UK
| | - Rachael Powell
- Manchester Centre for Health Psychology School of Health Sciences The University of Manchester UK
| | - David P. French
- Manchester Centre for Health Psychology School of Health Sciences The University of Manchester UK
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Muhwava LS, Murphy K, Zarowsky C, Levitt N. Experiences of lifestyle change among women with gestational diabetes mellitus (GDM): A behavioural diagnosis using the COM-B model in a low-income setting. PLoS One 2019; 14:e0225431. [PMID: 31765431 PMCID: PMC6876752 DOI: 10.1371/journal.pone.0225431] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 11/05/2019] [Indexed: 12/17/2022] Open
Abstract
Background Lifestyle change can reduce the risk of developing type 2 diabetes among women with prior gestational diabetes mellitus (GDM). While understanding women’s lived experiences and views around GDM is critical to the development of behaviour change interventions to reduce this risk, few studies have addressed this issue in low- and middle- income countries. The aim of the study was to explore women’s lived experiences of GDM and the feasibility of sustained lifestyle modification after GDM in a low-income setting. Methods This was a descriptive qualitative study on the lived experiences of women with prior GDM, who received antenatal care at a public sector tertiary hospital in Cape Town, South Africa. Nine focus groups and five in-depth interviews were conducted with a total of thirty-five women. Data were analysed using content analysis and the COM-B (Capabilities, Opportunities, Motivations and Behaviour) model to identify factors influencing lifestyle change during and beyond the GDM pregnancy. Results The results suggest that the COM-B model’s concepts of capability (knowledge and skills for behaviour change), opportunity (resources for dietary change and physical activity) and motivation (perception of future diabetes risk) are relevant to lifestyle change among GDM women in South Africa. The results will contribute to the design of a postpartum health system intervention for women with recent GDM. Conclusion Our findings highlight the need for health services to improve counselling and education for women with GDM in South Africa. Support from family and health professionals is essential for women to achieve lifestyle change. The experience of GDM imposed a significant psychological burden on women, which affected motivation for lifestyle change. To achieve long-term lifestyle change, behaviour interventions for women with prior GDM need to address their capability, opportunity and motivation for lifestyle change during and beyond pregnancy.
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Affiliation(s)
- Lorrein Shamiso Muhwava
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Chronic Diseases Initiative for Africa, Cape Town, South Africa
- * E-mail:
| | - Katherine Murphy
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Chronic Diseases Initiative for Africa, Cape Town, South Africa
| | - Christina Zarowsky
- Chronic Diseases Initiative for Africa, Cape Town, South Africa
- University of Montreal, Hospital Research Centre and University of Montreal School of Public Health, Montreal, Canada
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Naomi Levitt
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Chronic Diseases Initiative for Africa, Cape Town, South Africa
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Hiranput S, Ahmed SH, Macaulay D, Azmi S. Successful Outcomes with Insulin Degludec in Pregnancy: A Case Series. Diabetes Ther 2019; 10:283-289. [PMID: 30443804 PMCID: PMC6349292 DOI: 10.1007/s13300-018-0532-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Indexed: 10/29/2022] Open
Abstract
Optimal glycaemic control pre-conception and throughout pregnancy is paramount to achieve the best outcomes and to minimise the risk of complications for the mother and baby. Current long-acting insulin analogues that have been approved by the National Institute for Health and Care Excellence in the UK for use in pregnancy include glargine and detemir. In many patients, these treatments have limitations because of their pharmacokinetic properties thus not enabling optimal glycaemic control. Efforts at rapidly achieving the recommended blood glucose targets with these analogues can be associated with recurrent and/or disabling hypoglycaemia. Degludec is a second-generation ultra-long-acting insulin analogue, which has been shown to mimic endogenous basal insulin production by the pancreas. This may offer patients better control with less hypoglycaemia where first-generation insulins fail. There are currently no randomised controlled studies to support the use of insulin degludec in pregnancy. We report three cases of women who were on insulin degludec during pregnancy and achieved successful outcomes. Two of them were commenced on this during pregnancy because of hypoglycaemia with licenced insulin therapy. All the women showed an improvement in glycaemic control during pregnancy. There was attenuation of a wide glycaemic variability as demonstrated by a continuous glucose monitoring (CGM) system in one of the patients. They all delivered healthy babies. This case series highlights the urgent need for large randomised control trials to establish the safety and efficacy of insulin degludec in pregnancy.
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Affiliation(s)
- Siwaporn Hiranput
- Department of Endocrinology and Metabolic Medicine, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - S Haris Ahmed
- Department of Endocrinology and Metabolic Medicine, Countess of Chester Hospital NHS Foundation Trust, Chester, UK.
| | - Deborah Macaulay
- Department of Endocrinology and Metabolic Medicine, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Shazli Azmi
- Manchester Diabetes Centre, Manchester University Foundation Trust, Manchester, UK
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Okely J, Mason C, Collier A, Dunnachie N, Swanson V. Diagnosis of gestational diabetes: a 'teachable moment'. Diabet Med 2019; 36:184-194. [PMID: 30118538 DOI: 10.1111/dme.13803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2018] [Indexed: 12/31/2022]
Abstract
AIMS Research regarding the determinants of concordance with gestational diabetes mellitus (GDM) treatment is limited. Here, we test whether the psychosocial changes outlined in the teachable moments model, as proposed by McBride et al. (McBride CM, Emmons KM, Lipkus IM. Understanding the potential of teachable moments: the case of smoking cessation. Health Educ Res 2003; 18: 156-170) are associated with following GDM treatment recommendations. METHODS Fifty-nine women completed a baseline questionnaire (1 week after GDM diagnosis) in which they reported risk perception, social support, emotional response, the importance of their maternal identity and self-efficacy. One month later, participants reported their concordance with instructions regarding glucose monitoring, diet and, if applicable, medication. We used regression analysis to test for associations between the psychosocial factors measured at baseline and concordance at 1-month follow-up. RESULTS Those who perceived their risk as higher or felt supported by family or friends were more likely to report a high level of concordance with GDM treatment. Emotional response, identity salience and self-efficacy were not related to concordance. CONCLUSIONS Future interventions designed to increase concordance could benefit from a focus on risk perception and social support, as these factors appear to be most strongly associated with following GDM treatment recommendations.
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Affiliation(s)
- J Okely
- Psychology Division, University of Stirling, Stirling
| | - C Mason
- Psychology Division, University of Stirling, Stirling
| | | | | | - V Swanson
- Psychology Division, University of Stirling, Stirling
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Dayyani I, Terkildsen Maindal H, Rowlands G, Lou S. A qualitative study about the experiences of ethnic minority pregnant women with gestational diabetes. Scand J Caring Sci 2019; 33:621-631. [DOI: 10.1111/scs.12655] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/18/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Ida Dayyani
- School of Midwifery University College Nordjylland Aalborg Denmark
| | | | - Gillian Rowlands
- Department of Public Health Aarhus University Aarhus Denmark
- Institute of Health and Society New Castle University New Castle UK
| | - Stina Lou
- Defactum – Public Health and Health Services Research Central Denmark Region Aarhus Denmark
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