Diabetes in pregnancy: Women's views of care in a multi-ethnic, low socioeconomic population with midwifery continuity-of-care

BACKGROUND

Diabetes in pregnancy is diagnosed in 6% of pregnancies annually in Aotearoa-New Zealand, disproportionately affecting multi-ethnic, low socio-economic women. Little is known about the care experience of this population within the model of midwifery continuity-of-care, including views of telehealth care.

AIM

Increase understanding of the experience of diabetes in pregnancy care, including telehealth, among multi-ethnic, low socio-economic women receiving midwifery continuity-of-care.

METHODS

Qualitative interview study with primarily indigenous and migrant women who had diabetes in pregnancy and gave birth 6-18 months previously. Interviewers were matched with participants by ethnicity. Transcripts were analysed using Framework analysis.

RESULTS

Participants were 19 women (5 Māori, 5 Pacific Peoples, 5 Asian, 4 European). Data analysis revealed three key themes: 1) 'shock, shame, and adjustment' to the diagnosis 2) 'learning to manage diabetes in pregnancy' and 3) 'preparation for birth and beyond' to the postpartum period.

DISCUSSION

Receiving the diagnosis of diabetes in pregnancy was a shock. Managing diabetes during pregnancy was particularly challenging for indigenous and migrant women, who wished for better access to culturally appropriate dietary and lifestyle information. Women appreciated having options of telehealth and face-to-face consultations. Preparation for birth and postpartum diabetes follow-up were areas requiring significant improvement. Challenges were mitigated through care from a consistent diabetes specialist midwife and community-based midwifery continuity-of-care.

CONCLUSION

Midwives were the backbone of diabetes in pregnancy care for this multi-ethnic, low socio-economic population. Care could be improved with more culturally appropriate diet and lifestyle information, better birth preparation, and expanded postpartum diabetes support.

Teleclinics for the management of diabetes in pregnancy during COVID-19-maternal satisfaction and pregnancy outcomes

AIMS

Diabetes in pregnancy (DiP) rates are increasing worldwide. Pasifika, Indian and Māori peoples have high rates of DiP any improvements in clinical care may be beneficial for these populations. During COVID-19 lockdowns, the DiP service in Counties Manukau Health (CMH) South Auckland switched from face-to-face appointments to teleclinics. This study aims to: determine satisfaction of pregnant people with teleclinics for DiP; compare clinical outcomes and attendance for those receiving care through teleclinics versus standard care; and compare rates of clinic attendance between face-to-face and teleclinic appointments.

METHODS

A standardised questionnaire was completed by those who had attended a teleclinic. The primary outcome was a high score (4-5/5) for satisfaction and future use. A separate, retrospective study of clinical outcomes, and the number of appointments scheduled/attended were compared between all DiP patients who were scheduled an appointment during lockdown, and all of those who were scheduled appointments the year prior.

RESULTS

Of the thirty-five participants who completed the survey (response rate 37%), 89% scored the clinic highly for satisfaction and future use. There were 179 patients scheduled to clinic during the period where teleclinics were the default model of care, and 187 patients scheduled to clinic the year prior. No differences in clinical outcomes were observed. Those receiving care during lockdown were offered more appointments, although attendance rates did not differ.

CONCLUSION

Teleclinics for DiP are acceptable to the people we surveyed, but should be developed further so they better support the needs of those using them.