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Tschirhart H, Landeen J, Yost J, Nerenberg KA, Sherifali D. The Examination and Exploration of Diabetes Distress in Pre-existing Diabetes in Pregnancy: A Mixed-methods Study. Can J Diabetes 2024; 48:281-289.e2. [PMID: 38492737 DOI: 10.1016/j.jcjd.2024.03.001] [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: 09/07/2023] [Revised: 01/15/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES Diabetes distress (DD) has been understudied in the pregnancy population. Pregnancy is known to be a complex, highly stressful time for women with diabetes because of medical risks and the high burden of diabetes management. Our aim in this study was to explain and understand DD in women with pre-existing diabetes in pregnancy. METHODS An explanatory, sequential mixed-methods study was undertaken. The first strand consisted of a cross-sectional study of 76 women with type 1 and type 2 diabetes. A nested sampling approach was used to re-recruit 18 women back into the second strand for qualitative interviews using an interpretive description approach. RESULTS DD was measured by the validated Problem Area in Diabetes (PAID) scale. A PAID score of ≥40 was positive for distress. DD prevalence was 22.4% in the cross-sectional cohort and the average PAID score was 27.75 (standard deviation 16.08). In the qualitative strand, women with a range of PAID scores (10.0 to 60.0) were sampled for interviews. The majority of these participants described themes of DD in their interviews. Of the 15 women who described DD thematically, only 6 had positive PAID scores. CONCLUSIONS Integration of the mixed-methods data underscores important meta-inferences about DD in pregnancy, namely that DD was present to a greater degree than the PAID tool is sensitive to. DD was present qualitatively in most of the qualitative sample, despite interviewing women with a range of PAID scores. Future research on a pregnancy-specific DD scale is needed.
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Affiliation(s)
- Holly Tschirhart
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Janet Landeen
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Yost
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, United States
| | - Kara A Nerenberg
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Tschirhart H, Landeen J, Yost J, Nerenberg KA, Sherifali D. Perceptions of diabetes distress during pregnancy in women with type 1 and type 2 diabetes: a qualitative interpretive description study. BMC Pregnancy Childbirth 2024; 24:232. [PMID: 38570742 PMCID: PMC10988880 DOI: 10.1186/s12884-024-06370-w] [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: 07/20/2023] [Accepted: 02/25/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Diabetes distress is commonly seen in adults with pre-existing diabetes and is associated with worsened glycemic management and self-management practices. While a majority of women report increased stress during pregnancy, it is unknown how women with type 1 or type 2 diabetes experience diabetes distress during this unique and transitional time. PURPOSE This study aimed to understand the experiences and perceptions of diabetes distress in women with pre-existing diabetes during pregnancy. METHODS A qualitative study using an interpretive description approach was conducted. In-depth, one to one interviewing was used to capture rich descriptions of the pregnancy experience. Nested, stratified, and theoretical sampling was used to recruit 18 participants with type 1 and type 2 diabetes from the quantitative strand of this mixed methods study. Constant comparative analysis was used to inductively analyze the data and develop themes. FINDINGS Four themes, each with several subthemes, emerged under the main finding of "Diabetes Distress": 1) Worry for Baby's Health - "What's this going to do to the baby?"' 2) Feeling Overwhelmed with Diabetes Management-"It just seemed unattainable"; 3) Living with Diabetes - "There's no way out" and 4) Cycle of Diabetes Distress. CONCLUSIONS The findings from this study identify the sources and experiences of diabetes distress during pregnancy in women with pre-existing diabetes. Diabetes distress often presents as cyclical and multifaceted during pregnancy, with elements of fear for the unborn baby, difficulties with diabetes management, and having negative lived experiences of diabetes. Further work is needed to develop appropriate screening tools for pregnancy and interventions to mitigate diabetes distress. Diabetes educators are well-positioned provide emotional support and person-centred self-management education to individuals with diabetes.
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Affiliation(s)
- Holly Tschirhart
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
| | - Janet Landeen
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Jennifer Yost
- M. Louise Fitzpatrick College of Nursing, Villanova University, Pennsylvania, USA
| | - Kara A Nerenberg
- Departments of Medicine, Obstetrics & Gynecology, and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada
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Jost E, Kosian P, Greiner GG, Icks A, Schmitz MT, Schmid M, Merz WM. Obstetric Medicine: the protocol for a prospective three-dimensional cohort study to assess maternity care for women with pre-existing conditions (ForMaT). Front Med (Lausanne) 2024; 10:1258716. [PMID: 38274449 PMCID: PMC10808351 DOI: 10.3389/fmed.2023.1258716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Background Pregnancies in women with pre-existing medical conditions are on the rise. These pregnancies are characterized by an increased rate of maternal and perinatal complications, which can result in higher health care expenditures and altered pregnancy experiences. The purpose of this study is to integrally analyze maternity care for women with pre-existing conditions in the framework of a risk-adapted, interdisciplinary care by recording three substantial parts of maternity care: (1) maternal and perinatal outcome; (2) hospital costs and reimbursements covering the period from preconception counseling or initial antenatal visit to discharge after birth; and (3) women's experience of reproductive choice and becoming a mother in the presence of a pre-existing condition. Methods In this observational, prospective, longitudinal, and monocentric cohort study, we aim to include a total of 1,500 women over a recruitment period of 15 months. Women registering for care at the Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Germany, are allocated to three groups based on their health and risk status: women with pre-existing conditions, as well as healthy women with obstetric risk factor and healthy women with a low-risk pregnancy. Participants are observed from time of initial consultation until discharge after birth. Analysis focuses on (1) maternal and perinatal outcome, especially rate of severe maternal and neonatal morbidity; (2) costs and reimbursements; and (3) surveys to capture of women's experience and health-related quality of life during the time of reproductive choice, pregnancy, and childbirth in the presence of pre-existing medical conditions. Discussion With its complex three-dimensional design, the ForMaT-Trial is aiming to provide a comprehensive analysis of pregnancy and childbirth in women with pre-existing conditions. The results may serve as a basis for counseling and care of these women. By analyzing costs of specialized care, data for discussing reimbursement are generated. Lastly, our results may increase awareness for the perception of reproductive choice, pregnancy and motherhood in this continuously rising population.Clinical trial registration: German Clinical Trials Register, DRKS00030061, October 28, 2022.
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Affiliation(s)
- Elena Jost
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Philipp Kosian
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Gregory Gordon Greiner
- Institute of Health Services Research and Health Economics, Faculty of Medicine, Center for Health and Society, Heinrich Heine University Düsseldorf and University Hospital, Düsseldorf, Germany
- Institute of Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research Germany, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Andrea Icks
- Institute of Health Services Research and Health Economics, Faculty of Medicine, Center for Health and Society, Heinrich Heine University Düsseldorf and University Hospital, Düsseldorf, Germany
- Institute of Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research Germany, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Marie-Therese Schmitz
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Waltraut M. Merz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
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Roddy J, McGowan L. What are the childbearing experiences of women with type 1 diabetes? A scoping review of qualitative literature. Midwifery 2024; 128:103884. [PMID: 37984081 DOI: 10.1016/j.midw.2023.103884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023]
Abstract
PROBLEM Type 1 diabetes is associated with the risk of adverse outcomes for mother and baby. BACKGROUND How pregnant people adapt to the challenges of type 1 diabetes and engage with healthcare professionals can affect how likely they will be to maintain good glycaemic control. Therefore, it is important to understand the childbearing and care experiences of women with type 1 diabetes. AIM To examine contemporary literature describing the childbearing experiences of women with type 1 diabetes over the last decade. METHOD The review follows 5 stages of Arksey and O'Malley's scoping review framework. Four databases were searched for English language publications 2012-2023 using indexed terms and Boolean operators. 64 studies were retrieved, 10 included in the review. Braun and Clarke's thematic synthesis process was used to collate findings. FINDINGS Five key themes emerged: 1. Glycaemic control dominates the childbearing journey, 2. Emphasis on risk, 3. Importance of social and peer support, 4. Care organisation, systems, and communication, 5. The impact of technology on the childbearing experience. CONCLUSION Based on lived experiences, women with type 1 diabetes value being treated as partners in their care by health professionals providing medical and midwifery services. Peer and social support from family, friends and the diabetes community can bring comfort and reassurance in a perceived 'medicalised' childbearing journey. Further research is needed on the impact of the use of type 1 diabetes technologies on childbearing experiences and how peer support can be incorporated into current care provision.
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Affiliation(s)
- Jenny Roddy
- Consultant Midwife Health Equity, Leeds Teaching Hospitals NHS Trust, England, UK.
| | - Linda McGowan
- Professor of Applied Health Research, School of Healthcare, University of Leeds, England, UK
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Haines AJ, Mackenzie L, Honey A, Middleton PG. Occupations and balance during the transition to motherhood with a lifetime chronic illness: A scoping review examining cystic fibrosis, asthma, and Type-1 diabetes. Aust Occup Ther J 2023; 70:730-744. [PMID: 37524324 DOI: 10.1111/1440-1630.12899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 06/30/2023] [Accepted: 07/08/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Throughout the transition to motherhood, changes are experienced across a woman's physical, mental, social, and occupational self. Maternal chronic illness adds the complexity of increased healthcare needs and navigating a high-risk, medicalised pregnancy, birth, and post-natal period. Literature concerning motherhood transitions in chronic illness generally focusses on the mother's medical health and pregnancy outcomes; little is known about the impacts on women's occupations, balance, and quality of life. Understanding these issues may help support women in a more tailored and holistic way. OBJECTIVE This scoping review aims to gather, analyse, and synthesise existing empirical research on occupational engagement and occupational balance as they impact on wellbeing and quality of life in women with a lifetime chronic illness before and during pregnancy and in early motherhood. METHOD The review follows the nine-stage framework described in the Joanna Briggs Institute Manual for Evidence Synthesis (2020). Five databases were searched: Embase, Medline, PsycINFO, CINAHL, Scopus, and OT Seeker. Data were extracted and examined via content analysis, described in narrative synthesis, summarised into a conceptual framework, and tabulated. FINDINGS A total of 8,655 papers were discovered on initial search. Following title and abstract screening, 220 full-text studies were assessed for eligibility, and 46 papers were finally included. Analysis generated four major themes: The Disrupted Transition Journey; Adaptation, Compromise and Choice; Outcomes; and Drawing on What's Available. The themes were conceptualised into a framework to explain how women sought to balance motherhood and illness-related occupations. Adequate access to information, social support, expert care, and financial resources improved both quality of life and healthcare compliance. CONCLUSION Findings of this scoping review deepen the understanding of occupational balance during the transition to motherhood in the context of lifetime chronic illness. Healthcare providers and supportive family and friends can use this knowledge to adapt their approach to assisting women with chronic illness on the motherhood journey. These findings may also inform further inquiry into the scope of occupational therapy practice with this population.
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Affiliation(s)
- Alena Jane Haines
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lynette Mackenzie
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anne Honey
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Peter G Middleton
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Centre for Investigation and Treatment of Respiratory Infections in Children and Adults, Westmead Campus, Westmead, New South Wales, Australia
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Toledo‐Chavarri A, Delgado J, Rodríguez‐Martín B. Perspectives of women living with type 1 diabetes regarding preconception and antenatal care: A qualitative evidence synthesis. Health Expect 2023; 27:e13876. [PMID: 37909855 PMCID: PMC10726142 DOI: 10.1111/hex.13876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/21/2023] [Accepted: 09/08/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION Pregnant women with type 1 diabetes may have an increased risk of complications for both the baby and themselves. Educational programmes, preconception planning, strict glycemic control and comprehensive medical care are some of the antenatal interventions that have been proposed to improve the outcomes of pregnant women with type 1 diabetes. While some evidence-based recommendations about antenatal care are included in clinical practice guidelines (CPGs), the views, and experiences of women with type 1 diabetes about these interventions are not well known. AIM To understand and synthesize the perceptions of women with type 1 diabetes about the interventions before pregnancy. METHOD A qualitative evidence synthesis (QES) was carried out with a framework analysis guided by the Cochrane Qualitative and Implementation Methods Group approach. Three online databases (Medline, Embase and Web of Science) were searched. We included qualitative articles that were published from 2011 to 2021 and which were available in English or Spanish. FINDINGS Ten references met the inclusion criteria of the study and were included. Three main themes were identified: (a) acceptability of antenatal care, (b) feasibility and implementation consideration and (c) equity and accessibility difficulties. CONCLUSION Continuity of care, coordination between health professionals and services, and a more holistic approach are the key aspects women say need to be considered for more acceptable, feasible and equitable preconception and antenatal care. PATIENT OR PUBLIC CONTRIBUTION This QES was carried out as part of the CPGs on diabetes mellitus type 1, carried out as part of the Spanish Network of Health Technology Assessment Agencies. In this CPG, the representatives of the patient associations are Francisco Javier Darias Yanes, from the Association for Diabetes of Tenerife, who has participated in all the phases of the CPG; Aureliano Ruiz Salmón and Julián Antonio González Hernández (representatives of the Spanish Diabetes Federation (FEDE) who have participated as collaborator and external reviewer, respectively.
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Affiliation(s)
- Ana Toledo‐Chavarri
- Canary Islands Health Research Institute Foundation, (FIISC)TenerifeSpain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS)MadridSpain
- Research Network on Health Services in Chronic Diseases (REDISSEC)Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)Spain
| | - Janet Delgado
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS)MadridSpain
- Department of Philosophy IUniversity of Granada, Campus Universitario de Cartuja CPGranadaSpain
| | - Beatriz Rodríguez‐Martín
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)Spain
- Department of Nursing, Physiotherapy and Occupational TherapyFaculty of Health Sciences, University of Castilla‐La ManchaTalavera de la Reina (Toledo)Spain
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Firoz T, Pineles B, Navrange N, Grimshaw A, Oladapo O, Chou D. Non-communicable diseases and maternal health: a scoping review. BMC Pregnancy Childbirth 2022; 22:787. [PMID: 36273124 PMCID: PMC9587654 DOI: 10.1186/s12884-022-05047-6] [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: 03/05/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background Non-communicable diseases [NCDs] are leading causes of ill health among women of reproductive age and an increasingly important cause of maternal morbidity and mortality worldwide. Reliable data on NCDs is necessary for accurate measurement and response. However, inconsistent definitions of NCDs make reliable data collection challenging. We aimed to map the current global literature to understand how NCDs are defined, operationalized and discussed during pregnancy, childbirth and the postnatal period. Methods For this scoping review, we conducted a comprehensive global literature search for NCDs and maternal health covering the years 2000 to 2020 in eleven electronic databases, five regional WHO databases and an exhaustive grey literature search without language restrictions. We used a charting approach to synthesize and interpret the data. Results Only seven of the 172 included sources defined NCDs. NCDs are often defined as chronic but with varying temporality. There is a broad spectrum of conditions that is included under NCDs including pregnancy-specific conditions and infectious diseases. The most commonly included conditions are hypertension, diabetes, epilepsy, asthma, mental health conditions and malignancy. Most publications are from academic institutions in high-income countries [HICs] and focus on the pre-conception period and pregnancy. Publications from HICs discuss NCDs in the context of pre-conception care, medications, contraception, health disparities and quality of care. In contrast, publications focused on low- and middle-income countries discuss NCDs in the context of NCD prevention. They take a life cycle approach and advocate for integration of NCD and maternal health services. Conclusion Standardising the definition and improving the articulation of care for NCDs in the maternal health setting would help to improve data collection and facilitate monitoring. It would inform the development of improved care for NCDs at the intersection with maternal health as well as through a woman's life course. Such an approach could lead to significant policy and programmatic changes with the potential corresponding impact on resource allocation. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05047-6.
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Affiliation(s)
- Tabassum Firoz
- Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT, USA
| | - Beth Pineles
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | | | - Alyssa Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | | | - Doris Chou
- World Health Organization, Geneva, Switzerland.
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Hall M, Oakey H, Penno MAS, McGorm K, Anderson AJ, Ashwood P, Colman PG, Craig ME, Davis EA, Harris M, Harrison LC, Haynes A, Morbey C, Sinnott RO, Soldatos G, Vuillermin PJ, Wentworth JM, Thomson RL, Couper JJ. Mental Health During Late Pregnancy and Postpartum in Mothers With and Without Type 1 Diabetes: The ENDIA Study. Diabetes Care 2022; 45:dc212335. [PMID: 35107582 DOI: 10.2337/dc21-2335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/15/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Pregnancy and type 1 diabetes are each associated with increased anxiety and depression, but the combined impact on well-being is unresolved. We compared the mental health of women with and without type 1 diabetes during pregnancy and postpartum and examined the relationship between mental health and glycemic control. RESEARCH DESIGN AND METHODS Participants were women enrolled from 2016 to 2020 in the Environmental Determinants of Islet Autoimmunity (ENDIA) study, a pregnancy to birth prospective cohort following children with a first-degree relative with type 1 diabetes. Edinburgh Postnatal Depression Scale (EPDS) and Perceived Stress Scale (PSS) were completed during the third trimester (T3) (median [interquartile range] 34 [32, 36] weeks) and postpartum (14 [13, 16] weeks) by 737 women (800 pregnancies) with (n = 518) and without (n = 282) type 1 diabetes. RESULTS EPDS and PSS scores did not differ between women with and without type 1 diabetes during T3 and postpartum. EPDS scores were marginally higher in T3: predicted mean (95% CI) 5.7 (5.4, 6.1) than postpartum: 5.3 (5.0, 5.6), independent of type 1 diabetes status (P = 0.01). HbA1c levels in type 1 diabetes were 6.3% [5.8, 6.9%] in T3 and did not correlate with EPDS or PSS scores. Reported use of psychotropic medications was similar in women with (n = 44 of 518 [8%]) and without type 1 diabetes (n = 17 of 282 [6%]), as was their amount of physical activity. CONCLUSIONS Overall, mental health in late pregnancy and postpartum did not differ between women with and without type 1 diabetes, and mental health scores were not correlated with glycemic control.
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Affiliation(s)
- Madeleine Hall
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Department of Diabetes and Endocrinology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Helena Oakey
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Megan A S Penno
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Kelly McGorm
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Amanda J Anderson
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Pat Ashwood
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter G Colman
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Maria E Craig
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Elizabeth A Davis
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Mark Harris
- The University of Queensland Diamantina Institute, Queensland, Australia
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Leonard C Harrison
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Aveni Haynes
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Claire Morbey
- Hunter Diabetes Centre, Merewether, New South Wales, Australia
| | - Richard O Sinnott
- Melbourne eResearch Group, School of Computing and Information Services, University of Melbourne, Melbourne, Victoria, Australia
| | - Georgia Soldatos
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia
| | - Peter J Vuillermin
- Faculty of Health, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Child Health Research Unit, Barwon Health, Geelong, Victoria, Australia
| | - John M Wentworth
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Rebecca L Thomson
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Jennifer J Couper
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Department of Diabetes and Endocrinology, Women's and Children's Hospital, Adelaide, South Australia, Australia
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Clever SN, Baulig S, Benecke A. Psychologische Herausforderungen bei Erwachsenen mit Typ-1-Diabetes. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1338-4332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungMenschen mit Typ-1-Diabetes müssen immer wieder verschiedene Anpassungsleistungen erbringen, um ihre Erkrankung und deren Therapie in den Alltag integrieren zu können. Gelingt dies nicht, können daraus Probleme beim Selbstmanagement der Krankheit resultieren. Doch trotz strukturierter Schulungsprogramme und leitliniengerechter, individuell zugeschnittener Therapieempfehlungen leben einige Menschen mit Typ-1-Diabetes mit chronisch erhöhten Blutzuckerwerten. Dabei scheint der Diabetes-Distress als Reaktion auf die erlebten Herausforderungen eine wichtige Rolle zu spielen und im Zusammenhang mit Problemen bei der glykämischen Kontrolle wie auch einer Therapievermeidung zu stehen. Um eine Chronifizierung des Diabetes-Distress zu verhindern, empfiehlt es sich daher, ein Screening auf diabetesbezogene Belastungen in der Versorgung von Menschen mit Typ-1-Diabetes zu etablieren. Dies kann mittels Fragebogen oder der Thematisierung im persönlichen Gespräch geschehen. Diabetesspezifische psychologische Interventionen können sowohl die diabetesbezogene emotionale Belastung als auch die glykämische Kontrolle verbessern, sind jedoch in Deutschland noch nicht in der Regelversorgung verfügbar.
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Affiliation(s)
- Susan Norah Clever
- Psychotherapiepraxis, Diabetespraxis Blankenese, Hamburg, Germany
- CEO, Medical Psychology Consultancy, Hamburg, Germany
| | - Susanne Baulig
- Poliklinische Institutsambulanz für Psychotherapie, Johannes-Gutenberg-Universität Mainz, Germany
| | - Andrea Benecke
- Poliklinische Institutsambulanz für Psychotherapie, Johannes-Gutenberg-Universität Mainz, Germany
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Johnsen M, Klingenberg C, Brand M, Revhaug A, Andreassen G. Antenatal breastmilk expression for women with diabetes in pregnancy - a feasibility study. Int Breastfeed J 2021; 16:56. [PMID: 34301285 PMCID: PMC8299162 DOI: 10.1186/s13006-021-00393-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Mothers with diabetes are less likely to achieve successful breastfeeding. Antenatal breastmilk expression (ABE) may facilitate earlier breastfeeding, but feasibility of introducing ABE and its acceptance among Scandinavian women have previously not been investigated. Methods This observational trial was conducted between the 1 January 2019 and the 12 March 2020 in Tromsø, Norway. We aimed to determine the feasibility of ABE in terms of practicality and acceptability among women with medically (metformin or insulin) treated diabetes. Women were invited to participate during antenatal visits from 32 weeks gestation. Participants received instruction and started ABE from gestation week 37 + 0. Participants, and their infants, were followed until 6–8 weeks after birth. We collected data on breastfeeding rates, infant hypoglycemia, transfer to the neonatal unit, and the women’s overall experience and satisfaction with antenatal breastmilk expression. Results Twenty-eight of 34 (82%) invited women consented to participate. All started ABE from week 37 + 0, and continued until hospital admission. No women reported any discomfort or side effects. Labor was induced at 38 weeks gestation. Twenty-four women brought harvested colostrum to the maternity ward, which was given to their infants during the first 24 h of life. Breastfeeding rates at discharge were 24/28 (86%) and 21/27 (78%) at 6–8 weeks after delivery. Seven (25%) infants were transferred to the neonatal unit; four because of hypoglycemia. Maternal satisfaction assessed 6–8 weeks after delivery revealed that all participants felt positive about the ABE, but one woman would not recommend it to other pregnant women. Conclusions Implementing a structured ABE guideline for women with medically treated diabetes was feasible. The intervention was associated with high level of satisfaction among study participants. No obvious side effects were observed, and breastfeeding rates at discharge and 6–8 weeks after delivery were higher than in comparable studies. Trial registration The study was registered at the research study registry at the University Hospital of North Norway (Nr 2018/7181).
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Affiliation(s)
- Maren Johnsen
- Department of Obstetrics and Gynecology, Division of Surgery, Oncology and Women's Health, University Hospital of North Norway, Tromsø, Norway.
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.,Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Meta Brand
- Department of Obstetrics and Gynecology, Division of Surgery, Oncology and Women's Health, University Hospital of North Norway, Tromsø, Norway
| | - Arthur Revhaug
- Department of Digestive Surgery, Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway.,Division of Surgery, Oncology and Women's Health, University Hospital North Norway, Tromsø, Norway
| | - Gunnbjørg Andreassen
- Department of Obstetrics and Gynecology, Division of Surgery, Oncology and Women's Health, University Hospital of North Norway, Tromsø, Norway
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11
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Do-It-Yourself Artificial Pancreas System Use in Pregnant Women With Type 1 Diabetes in a Real-World Setting: 2 Case Reports. Can J Diabetes 2021; 45:804-808.e2. [PMID: 33648862 DOI: 10.1016/j.jcjd.2021.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/06/2021] [Accepted: 01/10/2021] [Indexed: 12/12/2022]
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12
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Dahlberg H, Berg M. The lived experiences of healthcare during pregnancy, birth, and three months after in women with type 1 diabetes mellitus. Int J Qual Stud Health Well-being 2020; 15:1698496. [PMID: 31825747 PMCID: PMC6922046 DOI: 10.1080/17482631.2019.1698496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Being pregnant, giving birth, and becoming a mother the first months after birth, is for women with type 1 diabetes mellitus (T1DM) a period of difficult challenges. In order to identify their need of support from healthcare, the aim of this study was to describe healthcare during pregnancy, labour, birth, and up to 12 weeks after birth as experienced by Swedish women with T1DM. We used a phenomenological reflective lifeworld research approach, and made 1-2 individual interviews with ten women in late pregnancy and/or 2-3 months after. Transcribed interviews were analysed through focusing on the meanings of the study phenomenon. The results revealed how the diabetes disease, as well as the risks and responsibility that comes with it, become more visible during the period in question, due to a constant monitoring, performed by the woman herself as well as by the healthcare professionals. The essential meaning of the phenomenon is a need to share the burden of risks and responsibilities with healthcare professionals. The complex situation that these women are in, both as experts on their illness and care and in need of care, requires a care that make women feel capable and responsible, but at the same time offers support and relieve them of their responsibility when needed.
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Affiliation(s)
- Helena Dahlberg
- Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Centre for Person-centred Care, University of Gothenburg, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Centre for Person-centred Care, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics, Sahlgrenska University Hospital, Gothenburg, Sweden
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13
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Singh H, Ingersoll K, Gonder-Frederick L, Ritterband L. "Diabetes Just Tends to Take Over Everything": Experiences of Support and Barriers to Diabetes Management for Pregnancy in Women With Type 1 Diabetes. Diabetes Spectr 2019; 32:118-124. [PMID: 31168282 PMCID: PMC6528394 DOI: 10.2337/ds18-0035] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
To optimize clinical outcomes, women with type 1 diabetes are advised to consistently achieve blood glucose levels in their target range before becoming pregnant. However, following this recommendation can be clinically and psychologically challenging for patients. We explored women's experiences of pregnancy-related diabetes management and any barriers and support systems affecting their self-management. Fifteen semi-structured telephone interviews were conducted with a nationwide sample. Interviews focused on women's perceptions of barriers hindering pregnancy-related diabetes management and support systems facilitating their self-management. Audio recordings were analyzed using inductive thematic analysis. Results indicated significant impairment of psychological health and overall quality of life in women with type 1 diabetes who were pregnant or planning pregnancy. Most participants reported a lack of support and empathetic engagement from their health care team, which affected their clinical management. Guilt and concerns about high blood glucose levels, constant pressure to meet glucose targets, and difficult interactions with health care professionals were a few of the primary themes with regard to barriers to optimal management. Patient-centered programs that provide effective clinical and psychosocial support for women who are preparing for pregnancy with preexisting diabetes are urgently needed so that these women feel adequately supported and empowered to undertake pregnancy.
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Affiliation(s)
- Harsimran Singh
- Mary & Dick Allen Diabetes Center, Hoag Memorial Hospital Presbyterian, Newport Beach, CA
| | - Karen Ingersoll
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA
| | - Linda Gonder-Frederick
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA
| | - Lee Ritterband
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA
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14
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Berg M, Linden K, Adolfsson A, Sparud Lundin C, Ranerup A. Web-Based Intervention for Women With Type 1 Diabetes in Pregnancy and Early Motherhood: Critical Analysis of Adherence to Technological Elements and Study Design. J Med Internet Res 2018; 20:e160. [PMID: 29720365 PMCID: PMC5956162 DOI: 10.2196/jmir.9665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 12/15/2022] Open
Abstract
Background Numerous Web-based interventions have been implemented to promote health and health-related behaviors in persons with chronic conditions. Using randomized controlled trials to evaluate such interventions creates a range of challenges, which in turn can influence the study outcome. Applying a critical perspective when evaluating Web-based health interventions is important. Objective The objective of this study was to critically analyze and discuss the challenges of conducting a Web-based health intervention as a randomized controlled trial. Method The MODIAB-Web study was critically examined using an exploratory case study methodology and the framework for analysis offered through the Persuasive Systems Design model. Focus was on technology, study design, and Web-based support usage, with special focus on the forum for peer support. Descriptive statistics and qualitative content analysis were used. Results The persuasive content and technological elements in the design of the randomized controlled trial included all four categories of the Persuasive Systems Design model, but not all design principles were implemented. The study duration was extended to a period of four and a half years. Of 81 active participants in the intervention group, a maximum of 36 women were simultaneously active. User adherence varied greatly with a median of 91 individual log-ins. The forum for peer support was used by 63 participants. Although only about one-third of the participants interacted in the forum, there was a fairly rich exchange of experiences and advice between them. Thus, adherence in terms of social interactions was negatively affected by limited active participation due to prolonged recruitment process and randomization effects. Lessons learned from this critical analysis are that technology and study design matter and might mutually influence each other. In Web-based interventions, the use of design theories enables utilization of the full potential of technology and promotes adherence. The randomization element in a randomized controlled trial design can become a barrier to achieving a critical mass of user interactions in Web-based interventions, especially when social support is included. For extended study periods, the technology used may need to be adapted in line with newly available technical options to avoid the risk of becoming outdated in the user realm, which in turn might jeopardize study validity in terms of randomized controlled trial designs. Conclusions On the basis of lessons learned in this randomized controlled trial, we give recommendations to consider when designing and evaluating Web-based health interventions.
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Affiliation(s)
- Marie Berg
- Centre for Person-Centred Care (GPCC), Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karolina Linden
- Centre for Person-Centred Care (GPCC), Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Carina Sparud Lundin
- Centre for Person-Centred Care (GPCC), Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Agneta Ranerup
- Department of Applied Information Technology, University of Gothenburg, Gothenburg, Sweden
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15
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Well-being, diabetes management and breastfeeding in mothers with type 1 diabetes – An explorative analysis. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 15:77-82. [DOI: 10.1016/j.srhc.2017.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/06/2017] [Accepted: 12/15/2017] [Indexed: 11/22/2022]
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16
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Linden K, Berg M, Adolfsson A, Sparud‐Lundin C. Person-centred, web-based support in pregnancy and early motherhood for women with Type 1 diabetes mellitus: a randomized controlled trial. Diabet Med 2018; 35:232-241. [PMID: 29171071 PMCID: PMC5814869 DOI: 10.1111/dme.13552] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 12/11/2022]
Abstract
AIMS To report results from and explore use of a multicentre, parallel-group, unblinded, randomized controlled trial testing the effectiveness in terms of well-being and diabetes management of a person-centred, web-based support programme for women with Type 1 diabetes, in pregnancy and postpartum. METHODS Between 2011 and 2014, 174 pregnant women with Type 1 diabetes were randomly allocated (1:1) to web-based support and standard care (intervention group, n=83), or standard care (control group, n=91). The web-based support consisted of evidence-based information; a self-care diary for monitoring of daily activities; and peer support in a discussion forum. The primary outcomes (mean difference, measured at 6 months after childbirth) were well-being and diabetes management. RESULTS No differences were found with regard to the primary outcome measure scores for general well-being [1.04 (95% CI -1.28 to 3.37); P=0.68] and self-efficacy of diabetes management [0.08 (95% CI -0.12 to 0.28); P= 0.75], after adjustment for baseline differences in the insulin administration method, nor with regard to the secondary outcome measures. CONCLUSIONS At 6 months after childbirth, the web-based support plus standard care was not superior to standard care in terms of general well-being or self-efficacy of diabetes management. This might be explained by the low number of participants who had a high activity level. Few simultaneously active participants in the web-based programme and stressors in motherhood and diabetes postpartum were the main barriers to its use. Further intervention studies that offer web-based support are needed, with lessons learned from the present study. (Clinicaltrials.gov identification number: NCT015665824).
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Affiliation(s)
- K. Linden
- Centre for Person‐Centred CareInstitute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - M. Berg
- Centre for Person‐Centred CareInstitute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Obstetrics and GynecologySahlgrenska University HospitalGothenburgSweden
| | - A. Adolfsson
- School of Medical SciencesÖrebro UniversityÖrebroSweden
- Faculty of Health SciencesDepartment of Nursing ScienceUniversity College of Southeast NorwayKongsbergNorway
| | - C. Sparud‐Lundin
- Centre for Person‐Centred CareInstitute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
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17
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Draffin CR, Alderdice FA, McCance DR, Maresh M, Harper R, Patterson CC, Bernatavicius G, Brennan SF, Gough A, McSorley O, Holmes VA. Impact of an educational DVD on anxiety and glycaemic control in women diagnosed with gestational diabetes mellitus (GDM): A randomised controlled trial. Diabetes Res Clin Pract 2017; 126:164-171. [PMID: 28258027 DOI: 10.1016/j.diabres.2017.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/12/2017] [Accepted: 02/13/2017] [Indexed: 11/20/2022]
Abstract
AIMS The diagnosis of gestational diabetes mellitus (GDM) during pregnancy can lead to anxiety. This study evaluated the impact of an innovative patient-centred educational DVD on anxiety and glycaemic control in women newly diagnosed with GDM. METHODS 150 multi-ethnic women, aged 19-44years, from three UK hospitals were randomised to either usual care plus DVD (DVD group, n=77) or usual care alone (control group, n=73) at GDM diagnosis. Primary outcomes were anxiety (State-Trait Anxiety Inventory) and mean 1-h postprandial capillary self-monitored blood glucose for all meals, on day prior to follow-up. RESULTS No significant difference between the DVD and control group were reported, for anxiety (37.7±11.7 vs 36.2±10.9; mean difference after adjustment for covariates (95% CI) 2.5 (-0.8, 5.9) or for mean 1-h postprandial glucose for all meals (6.9±0.9 vs 7.0±1.2mmol/L; -0.2 (-0.5, 0.2). However, the DVD group had significantly lower postprandial breakfast glucose compared to the control group (6.8±1.2 vs 7.4±1.9mmol/L; -0.5 (-1.1, -<0.1; p=0.04). CONCLUSIONS The results in this trial did not highlight any differences between those who received the intervention and those who received usual care. It is possible that women already felt supported by their frequent attendance at specialist clinics for monitoring and advice. Healthcare professional and family support are key elements to empowering women with GDM and require further consideration in future interventions. Nonetheless, educational resources such as this will be beneficial to help support women given the current resource and time implications of the year on year rises in the incidence of gestational diabetes.
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Affiliation(s)
- Claire R Draffin
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Fiona A Alderdice
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - David R McCance
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Michael Maresh
- St Mary's Hospital, Central Manchester University Hospitals NHS FT, Manchester Academic Health Sciences Centre, UK
| | - Roy Harper
- Ulster Hospital, South Eastern Health and Social Care Trust, Dundonald, UK
| | - Christopher C Patterson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Giovanna Bernatavicius
- St Mary's Hospital, Central Manchester University Hospitals NHS FT, Manchester Academic Health Sciences Centre, UK
| | - Sarah F Brennan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Aisling Gough
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Oonagh McSorley
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Valerie A Holmes
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
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18
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Linden K, Sparud-Lundin C, Adolfsson A, Berg M. Well-Being and Diabetes Management in Early Pregnant Women with Type 1 Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E836. [PMID: 27556476 PMCID: PMC4997522 DOI: 10.3390/ijerph13080836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/15/2016] [Accepted: 08/18/2016] [Indexed: 12/16/2022]
Abstract
This paper explores well-being and diabetes management in women with type 1 diabetes mellitus (DM) in early pregnancy and investigates associations among perceived well-being, diabetes management, and maternal characteristics. Questionnaires were answered by 168 Swedish women. Correlation analyses were conducted with Spearman's correlation coefficient (rs). The women reported relatively high scores of self-efficacy in diabetes management (SWE-DES-10: 3.91 (0.51)) and self-perceived health (excellent (6.5%), very good (42.3%), good (38.7%), fair (11.3%) and poor (1.2%)). Moderate scores were reported for general well-being (WBQ-12: 22.6 (5.7)) and sense of coherence (SOC-13: 68.9 (9.7), moderate/low scores for hypoglycemia fear (SWE-HFS 26.6 (11.8)) and low scores of diabetes-distress (SWE-PAID-20 27.1 (15.9)). A higher capability of self-efficacy in diabetes management showed positive correlations with self-perceived health (rs = -0.41, p < 0.0001) and well-being (rs = 0.34, p < 0.0001) as well as negative correlations with diabetes distress (rs = -0.51, p < 0.0001) and hypoglycemia worries (rs = -0.27, p = 0.0009). Women with HbA1c levels of ≤48 mmL/mol scored higher in the subscales "goal achievement" in SWE-DES (p = 0.0028) and "comprehensibility" in SOC (p = 0.016). Well-being and diabetes management could be supported by strengthening the women's capability to achieve glycemic goals and their comprehensibility in relation to the treatment. Further studies are needed to test this.
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Affiliation(s)
- Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.
- Centre for Person-Centred Care (GPCC), University of Gothenburg, 405 30 Gothenburg, Sweden.
| | - Carina Sparud-Lundin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.
- Centre for Person-Centred Care (GPCC), University of Gothenburg, 405 30 Gothenburg, Sweden.
| | - Annsofie Adolfsson
- School of Health Sciences, Örebro University, 701 82 Örebro, Sweden.
- Faculty of Health Sciences, Department of Nursing Science, Vestfold University College of Southeast Norway, 3603 Kongsberg, Norway.
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.
- Centre for Person-Centred Care (GPCC), University of Gothenburg, 405 30 Gothenburg, Sweden.
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19
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Edwards H, Speight J, Bridgman H, Skinner TC. The pregnancy journey for women with type 1 diabetes: a qualitative model from contemplation to motherhood. PRACTICAL DIABETES 2016. [DOI: 10.1002/pdi.2036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Helen Edwards
- Diabetes Counselling Online; Adelaide South Australia Australia
| | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria; Melbourne Victoria
- Centre for Social and Early Emotional Development, School of Psychology; Victoria Australia
- AHP Research; Hornchurch UK
| | - Heather Bridgman
- Centre for Rural Health, School of Health Sciences, Faculty of Health; University of Tasmania; Launceston Tasmania Australia
| | - Timothy C Skinner
- School of Psychological and Clinical Sciences, Faculty of Engineering, Health, Science and the Environment; Charles Darwin University; Darwin Northern Territory Australia
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20
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Hannan J, Brooten D, Youngblut JM, Galindo AM. Comparing mothers' postpartum concerns in two clinical trials 18 years apart. J Am Assoc Nurse Pract 2016; 28:604-611. [PMID: 27273192 DOI: 10.1002/2327-6924.12384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 04/05/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND PURPOSE To determine if U.S. women's postpartum concerns have changed over time. METHODS Mothers' postpartum concerns were compared in two clinical trials: 1997 (high-risk pregnancy) and 2015 (first-time mothers). Advanced practice nurses (APNs) provided care through 8 weeks postpartum and recorded interactions in clinical logs. Content analysis of logs was used for identifying concerns. RESULTS Ninety-five percent of 58 1997 mothers were African American; 64% of 62 2015 mothers were Hispanic. The number of infant concerns (129 vs. 144) was similar to four of the top five infant concerns; infant feeding was the top concern for both groups. The 1997 mothers were concerned with body changes, birth control, breastfeeding, maternal health problems, and had more concerns about their health (142 vs. 43); the 2015 mothers were concerned with not having help, fatigue, finding things hard. Both groups had postpartum pain concerns and problems accessing mother/infant governmental programs. CONCLUSIONS Mothers' concerns regarding infant care were essentially the same over the two time periods with infant feeding as the top concern. Maternal concerns in common were postpartum pain and needing help accessing government programs. Women who had high-risk pregnancies had more health concerns. IMPLICATIONS FOR PRACTICE Results provide guidance for helping minority mothers in the postpartum period.
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Affiliation(s)
- Jean Hannan
- Nicole Wertheim College of Nursing and Health Sciences, Miami, Florida
| | - Dorothy Brooten
- Nicole Wertheim College of Nursing and Health Sciences, Miami, Florida
| | | | - Ali Marie Galindo
- Nicole Wertheim College of Nursing and Health Sciences, Miami, Florida
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21
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Goldschmidt VJ, Colletta B. The Challenges of Providing Diabetes Education in Resource-Limited Settings to Women With Diabetes in Pregnancy: Perspectives of an Educator. Diabetes Spectr 2016; 29:101-4. [PMID: 27182180 PMCID: PMC4865389 DOI: 10.2337/diaspect.29.2.101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
IN BRIEF In resource-limited settings, the challenges of providing diabetes education are magnified. To provide the best education, these challenges and barriers need to be identified and addressed. Many times, at the "teachable moment" of a gestational diabetes diagnosis, we are able to not only address the immediate concerns, but also help patients adopt and continue long-term healthy lifestyle behaviors that improve the health of their entire family.
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22
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Iversen MM, Graue M, Leksell J, Smide B, Zoffmann V, Sigurdardottir AK. Characteristics of nursing studies in diabetes research published over three decades in Sweden, Norway, Denmark and Iceland: a narrative review of the literature. Scand J Caring Sci 2015; 30:241-9. [PMID: 26333150 DOI: 10.1111/scs.12259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 06/01/2015] [Indexed: 11/29/2022]
Abstract
Similarities and differences across borders of Nordic countries constitute a suitable context for investigating and discussing factors related to the development of diabetes nursing research over the last three decades. The present study reviewed the entire body of contemporary diabetes nursing research literature originating in four Nordic countries: Norway, Sweden, Denmark and Iceland. Our aims were (i) to catalogue and characterise trends in research designs and research areas of these studies published over time and (ii) to describe how research involving nurses in Nordic countries has contributed to diabetes research overall. The larger goal of our analyses was to produce a comprehensive picture of this research in order to guide future studies in the field. We conducted a narrative literature review by systematically searching Medline, Medline in process, EMBASE, CINAHL, PsycINFO and Cochrane databases. These searches were limited to studies published between 1979 and 2009 that had an abstract available in English or a Nordic language. Two researchers independently selected studies for analysis, leading to the inclusion of 164 relevant publications for analysis. In summary, Nordic nurse researchers have contributed to the development of new knowledge in self-management of diabetes in childhood, adolescence and adulthood, and to some extent also in the treatment and care of diabetes foot ulcers. Future research may benefit from (i) larger nurse-led research programmes organised in networks in order to share knowledge and expertise across national groups and borders, (ii) more multidisciplinary collaborations in order to promote patient-centred care and (iii) further research directed towards improving the dissemination and implementation of research findings. Using complex intervention designs and a mix of research methods will enrich the research.
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Affiliation(s)
- Marjolein M Iversen
- Centre of Evidence-based Practice, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway.,Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Marit Graue
- Centre of Evidence-based Practice, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Janeth Leksell
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,The School of Education, Health and Social Studies, Dalarna University, Sweden
| | - Bibbi Smide
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Vibeke Zoffmann
- Research on Women's and Children's Health, Juliane Marie Centre, The University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
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23
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Bastani F. Effect of Acupressure on Maternal Anxiety in Women With Gestational Diabetes Mellitus: A Randomized Clinical Trial. Clin Nurs Res 2015; 25:325-41. [PMID: 25848127 DOI: 10.1177/1054773815579344] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Women with diabetes often experience a higher level of anxiety. The aim of the study was to evaluate the effect of acupressure on relieving anxiety of women with gestational diabetes mellitus (GDM). A randomized clinical trial was conducted on 60 women with GDM at a university hospital. The participants were allocated to an experimental and a placebo group (30 women per group). The experimental group received a nurse-provided acupressure at the true point, and the placebo group received pressure (touching) at a sham (false) point. Anxiety was measured immediately in the groups prior to and after a 2-day intervention by a questionnaire and the Visual Analogue Scale. The data were analyzed using descriptive and inferential statistics. Results indicated that the acupressure group had significantly lower anxiety than the placebo group (p ≤ .0001). In conclusion, the effects of acupressure appeared to be effective in reducing anxiety in diabetic pregnant women.
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24
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Woolley M, Jones C, Davies J, Rao U, Ewins D, Nair S, Joseph F. Type 1 diabetes and pregnancy: a phenomenological study of women's first experiences. PRACTICAL DIABETES 2015. [DOI: 10.1002/pdi.1914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Maria Woolley
- Department of Obstetrics; Countess of Chester Hospital NHS Foundation Trust; Chester UK
| | - Colin Jones
- Faculty of Health & Applied Social Sciences; Liverpool John Moores University; Liverpool UK
| | - Joanne Davies
- Department of Obstetrics; Countess of Chester Hospital NHS Foundation Trust; Chester UK
| | - Usha Rao
- Department of Obstetrics; Countess of Chester Hospital NHS Foundation Trust; Chester UK
| | - David Ewins
- Department of Diabetes and Endocrinology; Countess of Chester Hospital NHS Foundation Trust; Chester UK
| | - Sunil Nair
- Department of Diabetes and Endocrinology; Countess of Chester Hospital NHS Foundation Trust; Chester UK
| | - Frank Joseph
- Department of Diabetes and Endocrinology; Countess of Chester Hospital NHS Foundation Trust; Chester UK
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25
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Adolfsson A, Linden K, Sparud-Lundin C, Larsson PG, Berg M. A web-based support for pregnant women and new mothers with type 1 diabetes mellitus in Sweden (MODIAB-Web): study protocol for a randomized controlled trial. Trials 2014; 15:513. [PMID: 25543854 PMCID: PMC4414296 DOI: 10.1186/1745-6215-15-513] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/09/2014] [Indexed: 11/10/2022] Open
Abstract
Background Women with type 1 diabetes face particular demands in their lives in relation to childbearing. During pregnancy, in order to optimize the probability of giving birth to a healthy child, their blood glucose levels need to be as normal as possible. After childbirth, they experience a ‘double stress’: in addition to the ordinary challenges they face as new mothers, they also need to focus on getting their blood glucose levels normal. To improve self-management of diabetes and overall well-being in women with type 1 diabetes, a person-centered web-based support was designed to be tested in a randomized controlled trial (RCT) to be used during pregnancy and early motherhood. This protocol outlines the design of this RCT, which will evaluate the effectiveness of the specially designed web-based support for mothers with type 1 diabetes in Sweden. Methods/Design The study is designed as an RCT. The web support consists of three parts: 1) evidence-based information, 2) a self-care diary, and 3) communication with peers. The primary outcome is general well-being evaluated with the Well-Being Questionnaire short version (W-BQ12) and diabetes management evaluated with the Diabetes Empowerment Scale, short version (SWE-DES). Women attending six hospital-based antenatal care centers in Sweden are invited to participate. The inclusion period is November 2011 to late 2014. The allocation of participants to web support (intervention group) and to usual care (control group) is equal (1:1). In total, 68 participants in each group will be needed to reach a statistical power of 80% with significance level 0.05. Discussion The web support is expected to strengthen the women’s personal capacity and autonomy during pregnancy, breastfeeding, and early motherhood, leading to optimal well-being and diabetes management. Trial registration ClinicalTrials.gov: NCT01565824 (registration date March 27th 2012).
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Affiliation(s)
- Annsofie Adolfsson
- School of Health and Medical Sciences, Örebro University, SE, 701 82, Örebro, Sweden.
| | - Karolina Linden
- Institutes of Health and Care Science, Sahlgrenska Academy, Gothenburg University, Box 457, SE, 405 30, Gothenburg, Sweden. .,Centre for Person-Centred Care (GPCC), University of Gothenburg, Box 457, SE, 405 30, Gothenburg, Sweden.
| | - Carina Sparud-Lundin
- Institutes of Health and Care Science, Sahlgrenska Academy, Gothenburg University, Box 457, SE, 405 30, Gothenburg, Sweden. .,Centre for Person-Centred Care (GPCC), University of Gothenburg, Box 457, SE, 405 30, Gothenburg, Sweden.
| | - Per-Göran Larsson
- Department of Obstetrics and Gynecology, Skaraborg Hospital Skövde, SE, 541 85, Skövde, Sweden.
| | - Marie Berg
- Institutes of Health and Care Science, Sahlgrenska Academy, Gothenburg University, Box 457, SE, 405 30, Gothenburg, Sweden. .,Centre for Person-Centred Care (GPCC), University of Gothenburg, Box 457, SE, 405 30, Gothenburg, Sweden.
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Singh H, Murphy HR, Hendrieckx C, Ritterband L, Speight J. The challenges and future considerations regarding pregnancy-related outcomes in women with pre-existing diabetes. Curr Diab Rep 2013; 13:869-76. [PMID: 24013963 PMCID: PMC3836194 DOI: 10.1007/s11892-013-0417-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ineffective management of blood glucose levels during preconception and pregnancy has been associated with severe maternal and fetal complications in women with pre-existing diabetes. Studies have demonstrated that preconception counseling and pre-pregnancy care can dramatically reduce these risks. However, pregnancy-related outcomes in women with diabetes continue to be less than ideal. This review highlights and discusses a variety of patient, provider, and organizational factors that can contribute to these suboptimal outcomes. Based on the findings of studies reviewed and authors' clinical and research experiences, recommendations have been proposed focusing on various aspects of care provided, including improved accessibility to effective preconception and pregnancy-related care and better organized clinic consultations that are sensitive to women's diabetes and pregnancy needs.
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Affiliation(s)
- Harsimran Singh
- Department of Psychiatry & Neurobehavioral Sciences, Division of Behavioral Health and Technology, University of Virginia School of Medicine, 310 Old Ivy Way, Suite 102, Charlottesville, VA 22903, USA, Phone: (434) 924 5988 (for Dr. Ritterband)
- ; Phone: (434) 982 1022 (for Dr. Singh, Corresponding author)
| | - Helen R. Murphy
- Metabolic Research Laboratories and NIHR Cambridge Biomedical Centre, Level 4, Institute of Metabolic Science Box 289 Addenbrookes Hospital, Cambridge, CB2 0QQ, UK. Phone: +44 (0) 1223 769079
| | - Christel Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia – Vic, 570 Elizabeth Street, Melbourne 3000, Australia. Phone: +61 (0) 3 8648 1860 (for Dr. Hendrieckx), Phone: +61(0) 3 8648 1850 (for Dr. Speight)
- Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Australia
| | - Lee Ritterband
- Department of Psychiatry & Neurobehavioral Sciences, Division of Behavioral Health and Technology, University of Virginia School of Medicine, 310 Old Ivy Way, Suite 102, Charlottesville, VA 22903, USA, Phone: (434) 924 5988 (for Dr. Ritterband)
| | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia – Vic, 570 Elizabeth Street, Melbourne 3000, Australia. Phone: +61 (0) 3 8648 1860 (for Dr. Hendrieckx), Phone: +61(0) 3 8648 1850 (for Dr. Speight)
- Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Australia
- AHP Research, Uxbridge, UK
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Rasmussen B, Hendrieckx C, Clarke B, Botti M, Dunning T, Jenkins A, Speight J. Psychosocial issues of women with type 1 diabetes transitioning to motherhood: a structured literature review. BMC Pregnancy Childbirth 2013; 13:218. [PMID: 24267919 PMCID: PMC4222685 DOI: 10.1186/1471-2393-13-218] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 11/18/2013] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Life transitions often involve complex decisions, challenges and changes that affect diabetes management. Transition to motherhood is a major life event accompanied by increased risk that the pregnancy will lead to or accelerate existing diabetes-related complications, as well as risk of adverse pregnancy outcomes, all of which inevitably increase anxiety. The frequency of hyperglycaemia and hypoglycaemia often increases during pregnancy, which causes concern for the health and physical well-being of the mother and unborn child. This review aimed to examine the experiences of women with T1DM focusing on the pregnancy and postnatal phases of their transition to motherhood. METHODS The structured literature review comprised a comprehensive search strategy identifying primary studies published in English between 1990-2012. Standard literature databases were searched along with the contents of diabetes-specific journals. Reference lists of included studies were checked. Search terms included: 'diabetes', 'type 1', 'pregnancy', 'motherhood', 'transition', 'social support', 'quality of life' and 'psychological well-being'. RESULT Of 112 abstracts returned, 62 articles were reviewed in full-text, and 16 met the inclusion criteria. There was a high level of diversity among these studies but three common key themes were identified. They related to physical (maternal and fetal) well-being, psychological well-being and social environment. The results were synthesized narratively. CONCLUSION Women with type 1 diabetes experience a variety of psychosocial issues in their transition to motherhood: increased levels of anxiety, diabetes-related distress, guilt, a sense of disconnectedness from health professionals, and a focus on medicalisation of pregnancy rather than the positive transition to motherhood. A trusting relationship with health professionals, sharing experiences with other women with diabetes, active social support, shared decision and responsibilities for diabetes management assisted the women to make a positive transition. Health professionals can promote a positive transition to motherhood by proactively supporting women with T1DM in informed decision-making, by facilitating communication within the healthcare team and co-ordinating care for women with type 1 diabetes transitioning to motherhood.
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Affiliation(s)
- Bodil Rasmussen
- School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, Vic 3125, Australia
| | - Christel Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia – Vic, 570 Elizabeth Street, Melbourne, VIC 3000, Australia
- Centre for Mental Health and Well-being Research, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Vic 3125, Australia
| | - Brydie Clarke
- School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, Vic 3125, Australia
| | - Mari Botti
- School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, Vic 3125, Australia
- Epworth Health Care, Centre for Clinical Research Nursing, Epworth, Australia
| | - Trisha Dunning
- School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, Vic 3125, Australia
- Deakin University, Waterfront, PO Box 281, Geelong, Vic 3220, Australia
| | - Alicia Jenkins
- Department of Medicine, St Vincent’s Hospital, 4th Floor Clinical, Science Building, Melbourne University, 29 Regent Street, Fitzroy, Vic 3065, Australia
| | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia – Vic, 570 Elizabeth Street, Melbourne, VIC 3000, Australia
- Centre for Mental Health and Well-being Research, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Vic 3125, Australia
- AHP Research, 16 Walden Way, Hornchurch, UK
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Rasmussen B, Dunning T, Hendrieckx C, Botti M, Speight J. Transition to motherhood in type 1 diabetes: design of the pregnancy and postnatal well-being in transition questionnaires. BMC Pregnancy Childbirth 2013; 13:54. [PMID: 23445534 PMCID: PMC3599343 DOI: 10.1186/1471-2393-13-54] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 02/14/2013] [Indexed: 02/07/2023] Open
Abstract
Background Life transitions are associated with high levels of stress affecting health behaviours among people with Type 1 diabetes. Transition to motherhood is a major transition with potential complications accelerated by pregnancy with risks of adverse childbirth outcomes and added anxiety and worries about pregnancy outcomes. Further, preparing and going through pregnancy requires vigilant attention to a diabetes management regimen and detailed planning of everyday activities with added stress on women. Psychological and social well-being during and after pregnancy are integral for good pregnancy outcomes for both mother and baby. The aim of this study is to establish the face and content validity of two novel measures assessing the well-being of women with type 1 diabetes in their transition to motherhood, 1) during pregnancy and 2) during the postnatal period. Methods The approach to the development of the Pregnancy and Postnatal Well-being in T1DM Transition questionnaires was based on a four-stage pre-testing process; systematic overview of literature, items development, piloting testing of questionnaire and refinement of questionnaire. The questionnaire was reviewed at every stage by expert clinicians, researchers and representatives from consumer groups. The cognitive debriefing approach confirmed relevance of issues and identified additional items. Results The literature review and interviews identified three main areas impacting on the women’s postnatal self-management; (1) psychological well-being; (2) social environment, (3) physical (maternal and fetal) well-being. The cognitive debriefing in pilot testing of the questionnaire identified that immediate postnatal period was difficult, particularly when the women were breastfeeding and felt depressed. Conclusions The questionnaires fill an important gap by systematically assessing the psychosocial needs of women with type 1 diabetes during pregnancy and in the immediate postnatal period. The questionnaires can be used in larger data collection to establish psychometric properties. The questionnaires potentially play a key role in prospective research to determine the self-management and psychological needs of women with type 1 diabetes transitioning to motherhood and to evaluate health education interventions.
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Affiliation(s)
- Bodil Rasmussen
- Deakin University, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
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Berg M, Adolfsson A, Ranerup A, Sparud-Lundin C. Person-centered Web support to women with type 1 diabetes in pregnancy and early motherhood--the development process. Diabetes Technol Ther 2013; 15:20-5. [PMID: 23297670 DOI: 10.1089/dia.2012.0217] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pregnancy and early motherhood are extraordinarily demanding periods for women with type 1 diabetes, who therefore need optimal support. This article describes the process of developing person-centered Web-based support for women with type 1 diabetes during the period of pregnancy through early motherhood. Important aspects of person-centeredness are a broader scope of medicine, viewing the patient as a person, shared decision-making to accomplish a therapeutic alliance, and the role of documentation. MATERIALS AND METHODS A participatory design was used in the development process to capture the target group's knowledge, experiences, and needs, and a systematic process map for Web-based support was used to describe the process. RESULTS Content and layout in the Web support were developed collaboratively by project managers, advisory and scientific reference groups, technical producers, and representatives for the target group. Based on needs assessment and evidence synthesis, three main components of complementary Web-based support were identified: (1) specific information about pregnancy, childbirth, and early motherhood in relation to type 1 diabetes; (2) a self-care diary, including a device for documenting and evaluating blood glucose levels, insulin doses, food intake, physical activities, and overall well-being; and (3) a forum for communication between women with type 1 diabetes in the childbearing period. CONCLUSIONS Using a perspective of person-centered care, a participatory design and the process map were fruitful for developing person-centered Web support for self-care and self-learning. The developed Web support product will be evaluated in a randomized controlled trial and further developed based on this result.
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Affiliation(s)
- Marie Berg
- Institute of Health and Care Science, Sahlgrenska Academy, Gothenburg, Sweden.
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Letherby G, Stephen N, Stenhouse E. Pregnant women with pre-existing diabetes: family support in managing the pregnancy process. HUM FERTIL 2012; 15:200-4. [DOI: 10.3109/14647273.2012.742208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Berg M, Erlandsson LK, Sparud-Lundin C. Breastfeeding and its impact on daily life in women with type 1 diabetes during the first six months after childbirth: a prospective cohort study. Int Breastfeed J 2012; 7:20. [PMID: 23259843 PMCID: PMC3547744 DOI: 10.1186/1746-4358-7-20] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 12/16/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND For mothers with diabetes, breastfeeding is a great challenge due to their struggle with potentially unstable blood glucose levels. This paper explores breastfeeding attitudes and impact of breastfeeding on the daily life of mothers with type 1 diabetes compared with non-diabetic mothers. METHODS We performed a prospective cohort study of 108 mothers with type 1 diabetes and a reference group of 104 mothers in the west of Sweden. Data were collected through medical records and structured telephone interviews at 2 and 6 months after childbirth. RESULTS Women in both the diabetes group and the reference group had high levels of confidence (84% and 93% respectively) in their breastfeeding capacity before childbirth, and 90% assessed breastfeeding as a positive and an important experience during the six months of follow-up. About 80% assessed breastfeeding as influencing daily life 'very much' or 'quite a lot' at 2 months as did 60% at 6 months, with no difference between the groups. In mothers with diabetes, the impact of breastfeeding on the priority of other duties decreased over time, as did feelings of time pressure and negative effects on patterns of sleep. Compared to the reference group, mothers with diabetes at 6 months remained more affected by disruptions in daily life and they felt more worried about their health both at 2 and 6 months after childbirth. For the reference group mothers' sensitivity to unexpected disruptions in daily routines decreased between 2 and 6 months after childbirth, and they expressed a greater need to organize their time than mothers with diabetes. CONCLUSION Mothers with diabetes type 1 express more worry for own health and are more sensitive to distruptions. To balance their everyday life and to reduce the risk of stress and illhealth they are therefor, compared to other mothers, likely to need additional professional and peer support.
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Affiliation(s)
- Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Web-based information for pregnant women and new mothers with type 1 diabetes--a description of the development process. BMC Med Inform Decis Mak 2012; 12:134. [PMID: 23167552 PMCID: PMC3519759 DOI: 10.1186/1472-6947-12-134] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 11/12/2012] [Indexed: 11/25/2022] Open
Abstract
Background This paper describes the process of developing specifically designed web-based maternity information for women with type 1 diabetes. Methods A participatory design was used and the information was evaluated in seven stages by researchers, professional experts and users. All steps of the development process were noted in an online logbook. Results The information developed gradually and its contents were reviewed by nurse-midwives, nurses and physicians specializing in different key areas including diabetes care, paediatrics, obstetrics and breastfeeding, a clinical dietician and mothers with type 1 diabetes. The draft was reviewed in regard to its cultural suitability and the information material was adjusted to meet quality criterions. Finally, the text was adapted for a lay audience. Conclusions Using participatory design required time and resources, however; it proved a functional way of producing appropriate information for the target group.
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Adolfsson A, Jansson M. Prototype for Internet support of pregnant women and mothers with type 1 diabetes: focus group testing. Psychol Res Behav Manag 2012; 5:97-103. [PMID: 22915948 PMCID: PMC3417839 DOI: 10.2147/prbm.s32799] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background The aim of this study was to pilot test a prototype website called MODIAB-web designed to support pregnant women and mothers with type 1 diabetes. Method A focus group was undertaken and the results were analyzed using qualitative content analysis. Results Eight subthemes were identified, comprising “blood glucose versus insulin,” “application for smart phones,” “the time aspect,” “interface and technology,” “forum,” “direct link to the diabetes midwife,” “ask the expert,” and “lack of contact information.” These subthemes were condensed into two main themes. The first theme was “easily understood interface, but in need of a more blood-glucose focused orientation” and the second theme was “forum for interaction with both equals and experts.” Conclusion The women in this study had positive impressions of several of the MODIAB-web functions, including a forum for pregnant mothers with type 1 diabetes and the possibility of being able to put their blood glucose levels into a diagram which could be sent directly to the diabetes midwife. Access to articles and information via the “fact” tab and the ability to ask questions of experts were also significantly helpful to women in the focus group. Pregnant women and mothers with type 1 diabetes can gain support from such a Web-based self-help system.
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Experts' encounters in antenatal diabetes care: a descriptive study of verbal communication in midwife-led consultations. Nurs Res Pract 2012; 2012:121360. [PMID: 22685641 PMCID: PMC3362960 DOI: 10.1155/2012/121360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 02/22/2012] [Indexed: 01/10/2023] Open
Abstract
Aim. We regard consultations as cocreated communicatively by the parties involved. In this paper on verbal communication in midwife-led consultations, we consequently focus on the actual conversation taking place between the midwife and the pregnant woman with diabetes, especially on those sequences where the pregnant woman initiated a topic of concern in the conversation. Methods. This paper was undertaken in four hospital outpatient clinics in Norway. Ten antenatal consultations between midwives and pregnant women were audiotaped, transcribed to text, and analyzed using theme-oriented discourse analysis. Two communicative patterns were revealed: an expert's frame and a shared experts' frame. Within each frame, different communicative variations are presented. The topics women initiated in the conversations were (i) delivery, time and mode; (ii) previous birth experience; (iii) labor pain; and (iv) breast feeding, diabetes management, and fetal weight. Conclusion. Different ways of communicating seem to create different opportunities for the parties to share each other's perspectives. Adequate responses and a listening attitude as well as an ambiguous way of talking seem to open up for the pregnant women's perspectives. Further studies are needed to investigate the obstacles to, and premises for, providing midwifery care in a specialist outpatient setting.
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Sparud-Lundin C, Ranerup A, Berg M. Internet use, needs and expectations of web-based information and communication in childbearing women with type 1 diabetes. BMC Med Inform Decis Mak 2011; 11:49. [PMID: 21736713 PMCID: PMC3141376 DOI: 10.1186/1472-6947-11-49] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 07/07/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the childbearing period women use the internet both to seek information and as an important source of communication. For women with type 1 diabetes, pregnancy and early motherhood constitute a more complex situation than for women in general. This implies need for support from various professionals and a way of bridging any discontinuity in care would be to develop a website providing complementary social support and information. The objective of this study was to explore internet use, needs, and expectations regarding web-based information and communication in childbearing women with type 1 diabetes. METHODS Data were collected via a web-based survey with an explorative and descriptive design, in which 105 of 139 eligible mothers with type 1 diabetes and recent childbearing experience participated. The data were analyzed with descriptive and analytical statistics, and open answers with a directed content analysis. RESULTS Of the 105 women, 22% never used the internet to search for information concerning pregnancy, childbirth, and parenthood. 12% searched for information every day, 29% one or more times a week, and 38% one or more times a month. Of the women 44% declared themselves to be passive participants on social websites, and 45% to be active participants. 45% had specific expectations of web-based support directed towards childbearing, especially those with higher educational level (P = .01). Expectations of instrumental and informational support included an expert-controlled website with reliable, updated, and information focused on childbearing and diabetes, improved access to diabetes care professionals and alternative ways to communicate and to receive childbearing-related support. The women also asked for online technical devices to manage the frequent monitoring of blood glucose during pregnancy. Informal, emotional, and appraisal support from women in similar situations was suggested as a way to provide an arena for belonging instead of creating feelings of alienation. CONCLUSIONS Our results add important knowledge about the web-based needs of women with type 1 diabetes in relation to childbearing. This user directed study indicates specific areas of development for the provision of effective web-based support that includes facilities for reliable information, interactive support and social networking in this population.
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Affiliation(s)
- Carina Sparud-Lundin
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden.
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Modh C, Lundgren I, Bergbom I. First time pregnant women's experiences in early pregnancy. Int J Qual Stud Health Well-being 2011; 6:10.3402/qhw.v6i2.5600. [PMID: 21499449 PMCID: PMC3077216 DOI: 10.3402/qhw.v6i2.5600] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2011] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There are few studies focusing on women's experiences of early pregnancy. Medical and psychological approaches have dominated the research. Taking women's experiences seriously during early pregnancy may prevent future suffering during childbirth. AIM To describe and understand women's first time experiences of early pregnancy. METHOD Qualitative study using a phenomenological hermeneutic approach. Data were collected via tape-recorded interviews in two antenatal care units in Sweden. Twelve first time pregnant women in week 10-14, aged between 17 and 37 years participated. RESULTS To be in early pregnancy means for the women a life opening both in terms of life affirming and suffering. The central themes are: living in the present and thinking ahead, being in a change of new perspectives and values and being in change to becoming a mother. CONCLUSIONS The results have implications for the midwife's encounter with the women during pregnancy. Questions of more existential nature, instead of only focusing the physical aspects of the pregnancy, may lead to an improvement in health condition and a positive experience for the pregnant woman.
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Affiliation(s)
- Carin Modh
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Ingela Lundgren
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Ingegerd Bergbom
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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Risa CF, Lidén E, Friberg F. Communication patterns in antenatal diabetes care: an explorative and descriptive study of midwife-led consultations. J Clin Nurs 2011; 20:2053-63. [DOI: 10.1111/j.1365-2702.2010.03552.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lawrence JM. Women with diabetes in pregnancy: different perceptions and expectations. Best Pract Res Clin Obstet Gynaecol 2010; 25:15-24. [PMID: 21115403 DOI: 10.1016/j.bpobgyn.2010.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 10/06/2010] [Indexed: 12/16/2022]
Abstract
Given the increasing incidence of type 1 diabetes, the recent emergence of type 2 diabetes as a condition that can begin during childhood, and the increasing prevalence of gestational diabetes mellitus, the number of women who have some form of diabetes during their pregnancies is increasing. The perceptions and expectations of women with diabetes during pregnancy may affect their psychological response to pregnancy as well as their behaviour during and after pregnancy. This article provides an overview of the epidemiology of diabetes in pregnancy, including diabetes diagnosed before pregnancy and gestational diabetes mellitus. Then, the limited number of studies about women's perceptions of diabetes and pregnancy, based on interviews conducted during or shortly after pregnancy, are reviewed. We present information about how health professionals may manage these perceptions and expectations, based on the findings of these studies, as well as areas for future research.
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Affiliation(s)
- Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, 91101, USA.
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Persson M, Winkvist A, Mogren I. ‘From stun to gradual balance’- women’s experiences of living with gestational diabetes mellitus. Scand J Caring Sci 2009; 24:454-62. [DOI: 10.1111/j.1471-6712.2009.00735.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Berg M, Bondas T, Brinchmann BS, Lundgren I, Ólafsdóttir ÓÁ, Vehviläinen-Julkunen K, Hall EOC. Evidence-based care and childbearing—a critical approach. Int J Qual Stud Health Well-being 2009. [DOI: 10.1080/17482620802316089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Berg M, Sparud-Lundin C. Experiences of professional support during pregnancy and childbirth - a qualitative study of women with type 1 diabetes. BMC Pregnancy Childbirth 2009; 9:27. [PMID: 19575789 PMCID: PMC2725032 DOI: 10.1186/1471-2393-9-27] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Accepted: 07/03/2009] [Indexed: 11/22/2022] Open
Abstract
Background Women with type 1 diabetes are at high risk of complications during both pregnancy and childbirth. Stringent monitoring of blood sugar is required in order to improve the chance of giving birth to a healthy child; however, this increases the incidence of severe hypoglycaemia. The aim of this study was to explore the need for and experience of professional support during pregnancy and childbirth among women with type 1 diabetes. Methods The study has a lifeworld research approach. Six focus groups and four individual interviews were conducted with 23 women, 6–24 months after delivery. The participants were encouraged to narrate their experiences of pregnancy and childbirth in relation to glycaemic control, well-being and provided care. Data analysis was directed towards discovering qualitative meanings by identifying and clustering meaning units in the text. Further analysis identified eight themes of meaning, classified under pregnancy or childbirth, forming a basis for a final whole interpretation of the explored phenomenon. Results The women felt worry about jeopardizing the baby's health and this was sometimes made worse by care providers' manner and lack of competence and support. The increased attention from care providers during pregnancy was experienced as related to the health of the unborn child; not the mothers. Women who during pregnancy received care in a disconnected diabetes organisation were forced to act as messengers between different care providers. Conclusion Clarity in terms of defining responsibilities is necessary during pregnancy and childbirth, both among care providers and between the woman and the care provider. Furthermore, a decision must be made concerning how to delegate, transfer or share diabetes responsibility during labour between the care providers and the parents-to-be.
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Affiliation(s)
- Marie Berg
- The Institute of Health and Care Sciences, the Sahlgrenska Academy at Gothenburg University Box 457, SE-405 30, Göteborg, Sweden.
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Lavender T, Platt MJ, Tsekiri E, Casson I, Byrom S, Baker L, Walkinshaw S. Women's perceptions of being pregnant and having pregestational diabetes. Midwifery 2009; 26:589-95. [PMID: 19250724 DOI: 10.1016/j.midw.2009.01.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 01/08/2009] [Accepted: 01/11/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE to explore the experiences of White British and South East Asian women with type 1 and type 2 diabetes, and the perceived impact of diabetes on their reproductive health. DESIGN a hermeneutic phenomenological approach was used to explore the perceptions of women with diabetes from two different cultural backgrounds with varied reproductive health experiences. Focus groups and one-to-one interviews were used to elicit women's experiences. An interpretive analytical approach was conducted by two researchers. SETTING obstetric and diabetes clinics in three hospital sites in the North West of England. PARTICIPANTS a purposive sample of 22 women with type 1 or type 2 diabetes of different parity and ethnicity. FINDINGS the main themes were relinquishing personal control, pregnancy overshadowed by diabetes and haphazard preconception care. KEY CONCLUSIONS strategies should be developed to ensure that whilst safety is maintained, the pregnancy focus is not lost. Women should be supported to optimise their experience as well as clinical outcomes. The convergence of professional roles needs consideration; individual members of multidisciplinary diabetes teams should provide a unique and complementary contribution to care. Preconception care needs to be accessible and responsive to women; this should include recognition of socio-cultural differences.
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Affiliation(s)
- Tina Lavender
- University of Manchester, School of Nursing, Midwifery and Social Work, Oxford Road, Manchester M13 9PL, UK.
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Becoming pregnant: exploring the perspectives of women living with diabetes. Br J Gen Pract 2008; 58:184-90. [DOI: 10.3399/bjgp08x277294] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Kjaergaard H, Foldgast AM, Dykes AK. Experiences of non-progressive and augmented labour among nulliparous women: a qualitative interview study in a Grounded Theory approach. BMC Pregnancy Childbirth 2007; 7:15. [PMID: 17662152 PMCID: PMC1971051 DOI: 10.1186/1471-2393-7-15] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Accepted: 07/28/2007] [Indexed: 11/10/2022] Open
Abstract
Background Non-progressive labour is the most common complication in nulliparas and is primarily treated by augmentation. Augmented labour is often terminated by instrumental delivery. Little qualitative research has addressed experiences of non-progressive and augmented deliveries. The aim of this study was to gain a deeper understanding of the experience of non-progressive and augmented labour among nulliparas and their experience of the care they received. Methods A qualitative study was conducted using individual interviews. Data was collected and analysed according to the Grounded Theory method. The participants were a purposive sample of ten women. The interviews were conducted 4–15 weeks after delivery. Results The women had contrasting experiences during the birth process. During labour there was a conflict between the expectation of having a natural delivery and actually having a medical delivery. The women experienced a feeling of separation between mind and body. Interacting with the midwife had a major influence on feelings of losing and regaining control. Reconciliation between the contrasting feelings during labour was achieved. The core category was named Dialectical Birth Process and comprised three categories: Balancing natural and medical delivery, Interacting, Losing and regaining control. Conclusion A dialectical process was identified in these women's experiences of non-progressive labour. The process is susceptible to interaction with the midwife; especially her support to the woman's feeling of being in control. Midwives should secure that the woman's recognition of the fact that the labour is non-progressive and augmentation is required is handled with respect for the dialectical process. Augmentation of labour should be managed as close to the course of natural labour and delivery as possible.
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Affiliation(s)
- Hanne Kjaergaard
- Juliane Marie Centre for Women, Children and Reproduction, Rigshospitalet, Copenhagen University Hospital, Denmark
- Department of Health Sciences, Lund University, Sweden
| | - Anne Maria Foldgast
- Juliane Marie Centre for Women, Children and Reproduction, Rigshospitalet, Copenhagen University Hospital, Denmark
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Abstract
The relationship between the midwife and the woman is essential for a positive experience for woman during childbearing period, i.e. pregnancy, childbirth and the first postpartum phase. Thereby, the aim of this study was to delineate central concepts in the midwife-woman relationship, in normal as well as high-risk situations. A secondary analysis was performed on original texts from eight Swedish qualitative studies, all with a phenomenological or phenomenological-hermeneutic approach. Six pairs of concepts were elucidated; each one describing one aspect from the woman's perspective and one responsive aspect from the midwife. The pairs of concepts are: surrender-availability, trust-mediation of trust, participation-mutuality, loneliness-confirmation, differenceness-support uniqueness and creation of meaning-support meaningfulness. Disciplinary concepts about the midwife-woman relationship have evolved that are essential for care in both normal and high-risk contexts, and we suggest that they should be implemented as a guide for midwifery care.
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Affiliation(s)
- Ingela Lundgren
- School of Health Sciences, Borås University College, Borås, Sweden.
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