The holistic maternity care needs of women with Gestational Diabetes Mellitus: A systematic review with thematic synthesis

Women's experience of gestational diabetes and healthcare in southern Sweden - a qualitative study

BACKGROUND

Gestational diabetes is one of the most common pregnancy complications, affecting 14% of all pregnancies globally, and its prevalence is increasing. Gestational diabetes is associated with short and long-term complications for both the mother and their offspring, which are possible to prevent by glycemic control mainly facilitated by healthy lifestyle behaviors. Hence, women diagnosed with gestational diabetes have a significant role in disease management which can be perceived as burdensome. Previous research has well documented the psychological implications of diagnosis in the women and the need for support from healthcare. Despite the global burden of disease associated with gestational diabetes, recent qualitative studies exploring women's experiences are scarce, particularly in Sweden. Thus, highlighting a critical gap in understanding the impact of this condition and the women's experiences of diagnosis and prenatal healthcare, which this study aimed to address.

METHODS

Purposive sampling was used to recruit women with previous gestational diabetes in southern Sweden. Individual interviews were held with 17 participants according to a semi-structured interview guide. The interviews were audio recorded and transcribed verbatim. Data analysis was conducted according to qualitative content analysis.

RESULTS

The analysis generated 10 subcategories, which were grouped into three categories labeled: "experience of diagnosis", "a complex relationship with food" and "experience of prenatal healthcare". One theme emerged: to suddenly become a patient as opposed to an expectant mother. Most women were initially overwhelmed by the diagnosis and its consequences. They felt that healthy eating was important, despite it limiting their everyday lives, which also revealed a complicated relationship with food. Women felt supported during pregnancy but abandoned after labor. They requested additional information and emotional support from healthcare personnel, increased awareness and understanding of the treatment burden of gestational diabetes, improved person-centered care, and collaboration between healthcare providers, particularly to ensure better support in reducing future risk of disease.

CONCLUSIONS

This study provides an understanding of women's experience of gestational diabetes and the care provided in southern Sweden. Their views could improve future care regarding both successful gestational diabetes management and post-pregnancy follow-up to prevent long-term adverse health outcomes.

Women's experiences and needs in the use of digital technologies for the management of gestational diabetes: An integrative systematic review

INTRODUCTION

Gestational diabetes mellitus (GDM) represents a widespread complication occurring during pregnancy, posing potential risks to both expectant mothers and their babies. Evidence shows that digital technologies provide comparable levels of care to conventional methods for GDM self-management, which help to improve maternal and neonatal outcomes. This systematic review aimed to explore women's experiences in using digital technologies, inform future technology design for gestational diabetes and potentially help improve usability.

METHODS

An integrative systematic review including quantitative, qualitative and mixed-method studies. The search was conducted in five databases including CINAHL, Web of Science, Medline, Embase, and PsycInfo. Studies were eligible when including the experience of using digital technologies for GDM self-management from the women's perspective. The screening processes were conducted by two independent reviewers and reached an overall moderate agreement on inter-rater reliability. Quality appraisal was conducted using the Mixed Method Appraisal Tool version 2018.

RESULTS

Thirty peer-reviewed articles were included, with a predominant or partial focus on five types of digital technologies including mobile applications, virtual care services, webpages, digital devices, and online communities. Women's experiences and needs of using GDM digital technologies were synthesised into five overarching themes: (1) sufficient and straightforward GDM-relevant educational information; (2) advanced personalisation and broader commitments in coaching components; (3) easy data recording and advanced data visualisation in data management; (4) improved healthcare professionals' engagement; (5) development of online community interfaces.

CONCLUSION

This integrative systematic review gives information on the types of available features across technologies and specific preferences for features by women with GDM. According to the inferred gaps, efforts should be made to facilitate women's self-monitoring using data and feedback, provide personalised information corresponding to women's condition, meet different behaviour change needs using customised coaching features, and enable wider access to information and support.

"I didn't really fit into any boxes": understanding the experiences of women affected by cancer in pregnancy and up to one-year postpartum-a mixed-method systematic review

PURPOSE

Little is known about women's experiences of cancer during pregnancy and up to one-year postpartum. As the incidence of gestational cancer rises parallel to increasing rates of early onset cancers there is an imperative need to understand their experiences. The aim of this research is to understand women's experiences of gestational cancer during pregnancy and up to one-year postpartum.

METHODS

This systematic integrative review followed the JBI methodology for mixed method systematic reviews (MMSR) which integrates empirical data from qualitative and quantitative primary studies. The search strategy included electronic databases, APA PsycINFO, CINHAL, Medline, Scopus, and the Web of Science Core Collection. The review has been reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive methodological quality assessment was undertaken using the Mixed Methods Appraisal Tool (MMAT).

RESULTS

Thirteen studies were included, reporting on the experiences of 266 women. The findings represented the women's insight on the psychological impact of their gestational cancer, the impact on women's identity as a mother and a patient, and women's experiences of complex care.

CONCLUSIONS

Gestational cancer reflects an emerging focus of clinical practice and an opportunity for much needed new research to explore woman-centered care exploring supportive care needs and models of maternity care.

IMPLICATIONS FOR CANCER SURVIVORS

Women's experiences indicate that services are under-resourced to address the holistic and integrated supportive care needs of women affected by cancer across both maternity and cancer care teams.

Promoting breastfeeding in women with gestational diabetes mellitus in high-income settings: an integrative review

BACKGROUND

Breastfeeding provides many short- and long-term health benefits for mothers and their infants and is a particularly relevant strategy for women who experience Gestational Diabetes Mellitus (GDM) during pregnancy. However, breastfeeding rates are generally lower amongst this group of women than the general population. This review's objective is to identify the factors that influence breastfeeding by exploring the experiences and outcomes of women in in high-income health care contexts when there is a history of GDM in the corresponding pregnancy.

METHODS

A comprehensive search strategy explored the electronic databases Medline, CINAHL, Web of Science and Scopus for primary studies exploring breastfeeding practices for papers published between January 2011 and June 2023. All papers were screened independently by two researchers with included papers assessed using the Crowe Critical Appraisal tool. Findings were analysed using a narrative synthesis framework.

RESULTS

From an initial search result of 1037 papers, 16 papers representing five high-income nations were included in this review for analysis - the United States of America (n = 10), Australia (n = 3), Finland (n = 1), Norway (n = 1), and Israel (n = 1). Fifteen papers used a quantitative design, and one used a qualitative design. The total number of participants represented in the papers is 963,718 of which 812,052 had GDM and 151,666 did not. Women with an immediate history of GDM were as likely to initiate breastfeeding as those without it. However, they were more likely to have the first feed delayed, be offered supplementation, experience delayed lactogenesis II and or a perception of low supply. Women were less likely to exclusively breastfeed and more likely to completely wean earlier than the general population. Maternity care practices, maternal factors, family influences, and determinants of health were contextual and acted as either a facilitator or barrier for this group.

CONCLUSION

Breastfeeding education and support need to be tailored to recognise the individual needs and challenges of women with a history of GDM. Interventions, including the introduction of commercial milk formula (CMF) may have an even greater impact and needs to be very carefully considered. Supportive strategies should encompass the immediate and extended family who are major sources of influence.