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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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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:S1499-2671(24)00056-X. [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] [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 & 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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3
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Sangtani A, Owens L, Broome DT, Gogineni P, Herman WH, Harris LH, Oshman L. The Impact of New and Renewed Restrictive State Abortion Laws on Pregnancy-Capable People with Diabetes. Curr Diab Rep 2023; 23:175-184. [PMID: 37213059 DOI: 10.1007/s11892-023-01512-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE OF REVIEW When the Supreme Court handed down its decision in Dobbs v Jackson Women's Health Organization in June 2022, the constitutional right to abortion was no longer protected by Roe v Wade. Fifteen states now have total or near-total bans on abortion care or no clinics providing abortion services. We review how these restrictions affect the medical care of people with pregestational diabetes. RECENT FINDINGS Of the ten states with the highest percent of adult women living with diabetes, eight currently have complete or 6-week abortion bans. People with diabetes are at high risk of diabetes-related pregnancy complications and pregnancy-related diabetes complications and are disproportionately burdened by abortion bans. Abortion is an essential part of comprehensive, evidence-based diabetes care, yet no medical society has published guidelines on pregestational diabetes that explicitly discuss the importance and role of safe abortion care. Medical societies enacting standards for diabetes care and clinicians providing diabetes care must advocate for access to abortion to reduce pregnancy-related morbidity and mortality for pregnant people with diabetes.
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Affiliation(s)
- Ajleeta Sangtani
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Lauren Owens
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - David T Broome
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Preethi Gogineni
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - William H Herman
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Lisa H Harris
- Department of Obstetrics and Gynecology and Department of Women's and Gender Studies, University of Michigan, Ann Arbor, MI, USA
| | - Lauren Oshman
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
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Mirzakhani K, Khadivzadeh T, Faridhosseini F, Ebadi A. Development and psychometric evaluation of the High-Risk Pregnancy Well-Being Index in Mashhad: a methodological study. Reprod Health 2022; 19:218. [PMID: 36457135 PMCID: PMC9714023 DOI: 10.1186/s12978-022-01529-0] [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: 02/05/2022] [Accepted: 11/04/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Assessment of well-being in high-risk pregnancy (HRP) is the key to achieve positive maternal and fetal outcomes. Although there are a wide range of instruments for well-being assessment, none of them is comprehensive for well-being assessment in HRP. The present study aimed at the development and psychometric evaluation of the High-Risk Pregnancy Well-Being Index (HRPWBI). METHODS This methodological study was conducted using the Waltz's four-step method. The dimensions of well-being in HRP were determined based on a conceptual model and the blueprint and the item pool of HRPWBI were developed. Then, the face and the content validity were assessed and item analysis was performed. Construct validity was also assessed through exploratory factor analysis with principal component analysis on the data obtained from 376 women with HRP in Mashhad, Iran. Finally, internal consistency, test-retest stability, sensitivity, and interpretability of HRPWBI were assessed. RESULTS The scale- content validity index (SCVI) of HRPWBI was 0.91. In factor analysis, 33 items were loaded on seven factors which explained 53.77% of the total variance. Internal consistency, relative stability, absolute stability, sensitivity, and interpretability of HRPWBI were confirmed with a Cronbach's alpha of 0.84, a test-retest intraclass correlation coefficient of 0.97, a standard error of measurement of 0.92, a minimal detectable change of 8.09, and a minimal important change of 2.92, respectively. CONCLUSION HRPWBI is a valid and reliable instrument for well-being assessment among women with HRP. It can be used to assess well-being and the effects of well-being improvement interventions on well-being among women with HRP.
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Affiliation(s)
- Kobra Mirzakhani
- grid.411583.a0000 0001 2198 6209Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran ,grid.411583.a0000 0001 2198 6209Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Talat Khadivzadeh
- grid.411583.a0000 0001 2198 6209Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran ,grid.411583.a0000 0001 2198 6209Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farhad Faridhosseini
- grid.411583.a0000 0001 2198 6209Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Ebadi
- grid.411521.20000 0000 9975 294XBehavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran ,Research Center for Life & Health Sciences & Biotechnology of the Police, Direction oh Health, Rescue & Treatment, Police Headquarter, Tehran, Iran
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Dew MA, DiMartini AF, Posluszny DM, Myaskovsky L, Switzer GE, Puttarajappa C, Hickey GW, Sanchez PG, DeVito Dabbs AJ. Health-related quality of life and psychological indicators of thriving 15-19 years after heart or lung transplantation. Clin Transplant 2022; 36:e14768. [PMID: 35801650 PMCID: PMC9756395 DOI: 10.1111/ctr.14768] [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: 05/31/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Survival into the second decade after cardiothoracic transplantation (CTX) is no longer uncommon. Few data exist on any health-related quality of life (HRQOL) impairments survivors face, or whether they may even experience positive psychological outcomes indicative of "thriving" (e.g., personal growth). We provide such data in a long-term survivor cohort. METHODS Among 304 patients prospectively studied across the first 2 years post-CTX, we re-interviewed patients ≥15 years post-CTX. We (a) examined levels of HRQOL and positive psychological outcomes (posttraumatic growth related to CTX, purpose in life, life satisfaction) at follow-up, (b) evaluated change since transplant with mixed-effects models, and (c) identified psychosocial and clinical correlates of study outcomes with multivariable regression. RESULTS Of 77 survivors, 64 (83%) were assessed (35 heart, 29 lung recipients; 15-19 years post-CTX). Physical HRQOL was poorer than the general population norm and earlier post-transplant levels (P's < .001). Mental HRQOL exceeded the norm (P < .001), with little temporal change (P = .070). Mean positive psychological outcome scores exceeded scales' midpoints at follow-up. Life satisfaction, assessed longitudinally, declined over time (P < .001) but remained similar to the norm at follow-up. Recent hospitalization and dyspnea increased patients' likelihood of poor physical HRQOL at follow-up (P's ≤ .022). Lower sense of mastery and poorer caregiver support lessened patients' likelihood of positive psychological outcomes (P's ≤ .049). Medical comorbidities and type of CTX were not associated with study outcomes at follow-up. CONCLUSIONS Despite physical HRQOL impairment, long-term CTX survivors otherwise showed favorable outcomes. Clinical attention to correlates of HRQOL and positive psychological outcomes may help maximize survivors' well-being.
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Affiliation(s)
- Mary Amanda Dew
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Departments of Psychology, Epidemiology, and Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrea F. DiMartini
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Donna M. Posluszny
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Larissa Myaskovsky
- Department of Internal Medicine, University of New Mexico School of Medicine and Center for Healthcare Equity in Kidney Disease, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Galen E. Switzer
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Chethan Puttarajappa
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Gavin W. Hickey
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- UPMC Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Pablo G. Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Annette J. DeVito Dabbs
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
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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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Sklar J, Pyle L, Snell-Bergeon JK, Garcetti R, Joshee P, Demmitt JK, Polsky S. Glycemic variability and indices of glycemic control among pregnant women with type 1 diabetes (T1D) based on the use of continuous glucose monitoring share technology. J Matern Fetal Neonatal Med 2021; 35:8968-8974. [PMID: 34875947 DOI: 10.1080/14767058.2021.2008895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pregnancies complicated by type 1 diabetes (T1D) experience high levels of glycemic variability, which may be associated with adverse maternal and neonatal outcomes. Therefore, strategies that help pregnant women with T1D manage their glycemic control are of great interest. METHODS We examined associations with or without remote monitoring of Continuous Glucose Monitor (CGM) data by friends and family with indices of glycemic control and glycemic variability during pregnancies complicated by T1D in a pilot non-randomized trial (n = 28). During preconception or the first trimester, participants were placed in one of two groups based on device compatibility: (1) CGM Alone (n = 13): women without iPhone, iPad or iPod Touch; or (2) CGM Share (n = 15): women with iPhone, iPad, or iPod Touch and followers with devices compatible for data viewing. Linear mixed models were used to compare indices of glycemic control and glycemic variability over time between groups. RESULTS Participants using CGM Share had lower estimated HbA1c levels over time (p = .028), glucose management index (p = .041), and fewer glucose excursions >200 mg/dL in each trimester (p = .022) compared to those using CGM Alone. Participants using CGM Alone had higher high blood glucose index (p = .020), mean area under the curve (p = .026), and standard deviation (p = .046) compared to those using CGM Share. Other measures of glycemic variability did not differ between groups. CONCLUSION In this non-randomized pilot study, use of CGM Share was associated with improvements in several indices of glycemic control and glycemic variability.
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Affiliation(s)
- Julie Sklar
- Yale School of Public Health, Department of Chronic Disease Epidemiology, New Haven, CT, USA
| | - Laura Pyle
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Janet K Snell-Bergeon
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel Garcetti
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Prakriti Joshee
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jamie K Demmitt
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sarit Polsky
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Parenting Fears and Concerns during Pregnancy: A Qualitative Survey. NURSING REPORTS 2021; 11:891-900. [PMID: 34968276 PMCID: PMC8715455 DOI: 10.3390/nursrep11040082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/14/2021] [Accepted: 10/24/2021] [Indexed: 11/17/2022] Open
Abstract
Previous research on the fears and anxieties of expectant mothers has focused mostly on their fears about giving birth rather than parenting. This study aims to describe mothers' fears and concerns about parenthood during pregnancy and to examine the similarities and differences in the perspectives of primiparous and multiparous mothers. The qualitative research for this study was conducted in three postpartum units in Finland and focused on the responses to an open-ended question about parenting fears and concerns that was part of a questionnaire given to 250 mothers after they had given birth. The responses from the 128 mothers who answered this question were subject to inductive content analysis. Fears and concerns on parenthood included worries about coping with the future and everyday life with their new baby, the psychological burden of parenthood, their maternal resources and self-efficacy, meeting their baby's needs, their baby's health, concerns about their relationship with their partner and financial issues. Primiparous and multiparous mothers shared many of the same concerns, but some differences emerged. The findings contribute an interesting perspective to the social debate about declining birth rates and their psychosocial causes. Further studies are needed to examine the fears and concerns of younger adults, and even teens, about parenthood.
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Scime NV, Lee S, Jain M, Metcalfe A, Chaput KH. A Scoping Review of Breastfeeding in Women with Chronic Diseases. Breastfeed Med 2021; 16:851-862. [PMID: 34319788 DOI: 10.1089/bfm.2021.0129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Approximately 10-20% of mothers have a chronic disease. Studies on breastfeeding in women with chronic disease span multiple disciplines, and these have not been collated to synthesize knowledge and identify gaps. The objective of this review was to summarize published literature on breastfeeding in women with chronic disease. Methods: We conducted a scoping review of original research and systematic reviews identified in Medline, EMBASE, and CINAHL (1990-2019) and by hand searching on women with chronic diseases reporting on at least one breastfeeding-related topic. Conference abstracts, case-studies, and studies on pregnancy-induced conditions or lactation pharmacology were excluded. Content analysis and narrative synthesis were used to analyze findings. Results: We identified 128 articles that were predominantly quantitative (80.5%), conducted in Europe or North America (65.6%), analyzed sample sizes of <200 (57.0%), and published from 2010 onward (68.8%). Diabetes (42.2%), multiple sclerosis (MS; 19.5%), and epilepsy (13.3%) were the most common diseases studied. Breastfeeding was a primary focus in approximately half (53.1%) of the articles, though definitions were infrequently reported (32.8%). The most-studied topics were breastfeeding duration/exclusivity (55.7%), reasons for feeding behavior (19.1%), and knowledge and attitudes about breastfeeding (18.3%). Less studied topics (<10% of articles each) included milk expression behaviors, breastfeeding difficulties, and feeding supports. Conclusions: Existing literature focuses primarily on diabetes or MS, and breastfeeding behaviors and outcomes. Further research examining a broader range of chronic diseases, with large sample sizes, and sufficient breastfeeding measurement detail can improve our understanding of breastfeeding disparities in this population.
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Affiliation(s)
- Natalie V Scime
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Sangmin Lee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mandakini Jain
- Undergraduate Medical Education Program, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Undergraduate Medical Education Program, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Kathleen H Chaput
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Buschur EO, Polsky S. Type 1 Diabetes: Management in Women From Preconception to Postpartum. J Clin Endocrinol Metab 2021; 106:952-967. [PMID: 33331893 DOI: 10.1210/clinem/dgaa931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Indexed: 01/11/2023]
Abstract
CONTEXT This review presents an up-to-date summary on management of type 1 diabetes mellitus (T1DM) among women of reproductive age and covers the following time periods: preconception, gestation, and postpartum. EVIDENCE ACQUISITION A systematic search and review of the literature for randomized controlled trials and other studies evaluating management of T1DM before pregnancy, during pregnancy, and postpartum was performed. EVIDENCE SYNTHESIS Preconception planning should begin early in the reproductive years for young women with T1DM. Preconception and during pregnancy, it is recommended to have near-normal glucose values to prevent adverse maternal and neonatal outcomes, including fetal demise, congenital anomaly, pre-eclampsia, macrosomia, neonatal respiratory distress, neonatal hyperbilirubinemia, and neonatal hypoglycemia. CONCLUSION Women with T1DM can have healthy, safe pregnancies with preconception planning, optimal glycemic control, and multidisciplinary care.
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Affiliation(s)
| | - Sarit Polsky
- The University of Colorado Barbara Davis Center, Denver, CO, USA
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11
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Nosova EV, O'Malley G, Dassau E, Levy CJ. Leveraging technology for the treatment of type 1 diabetes in pregnancy: A review of past, current, and future therapeutic tools. J Diabetes 2020; 12:714-732. [PMID: 32125763 DOI: 10.1111/1753-0407.13030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 12/16/2022] Open
Abstract
The significant risks associated with pregnancies complicated by type 1 diabetes (T1D) were first recognized in the medical literature in the mid-twentieth century. Stringent glycemic control with hemoglobin A1c (HbA1c) values ideally less than 6% has been shown to improve maternal and fetal outcomes. The management options for pregnant women with T1D in the modern era include a variety of technologies to support self-care. Although self-monitoring of blood glucose (SMBG) and multiple daily injections (MDI) are often the recommended management options during pregnancy, many people with T1D utilize a variety of different technologies, including continuous glucose monitoring (CGM), continuous subcutaneous insulin infusion (CSII), and CSII including automated delivery or suspension algorithms. These systems have yielded invaluable diagnostic and therapeutic capabilities and have the potential to benefit this understudied higher-risk group. A recent prospective, multicenter study evaluating pregnant patients with T1D revealed that CGM significantly improves maternal glycemic parameters, is associated with fewer adverse neonatal outcomes, and minimizes burden. Outcome data for CSII, which is approved for use in pregnancy and has been utilized for several decades, remain mixed. Current evidence, although limited, for commercially available and emerging technologies for the management of T1D in pregnancy holds promise for improving patient and fetal outcomes.
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Affiliation(s)
- Emily V Nosova
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Grenye O'Malley
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - Carol J Levy
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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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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Mirzakhani K, Ebadi A, Faridhosseini F, Khadivzadeh T. Well-being in high-risk pregnancy: an integrative review. BMC Pregnancy Childbirth 2020; 20:526. [PMID: 32912254 PMCID: PMC7488451 DOI: 10.1186/s12884-020-03190-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 08/19/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND A prerequisite to the interventions for well-being improvement in high-risk pregnancy (HRP) is to make the concept clear, objective, and measurable. Despite the wealth of studies into the concept of well-being in HRP, there is no clear definition for it. This study aimed to explore the concept of well-being in HRP. METHODS This integrative review was conducted using the Whittemore and Knafl's approach. A literature search was done without any data limitation in dictionaries, thesauruses, encyclopedias, well-being-related textbooks, midwifery, psychology, and mental health journals, and Iranian and international databases. The most primary inclusion criterion was relevance to well-being in HRP. The full-texts of all these articles were assessed using the checklists of the Joanna Briggs Institute. Data were analyzed through the constant comparison method and were managed using the MAXQDA 10 software. Meaning units were identified and coded. The codes were grouped into subcategories and categories according to the attributes, antecedents, and consequences of well-being in HRP. RESULTS Thirty articles were included in the review, from which 540 codes were extracted. The codes were grouped into seven main attributes, eight main antecedents, and five main consequences of well-being in HRP. The four unique dimensions of well-being in HRP are physical, mental-emotional, social, and spiritual well-being. These dimensions differentiate well-being in HRP from well-being in low-risk pregnancy and in non-pregnancy conditions. CONCLUSION As a complex and multidimensional concept, well-being in HRP refers to the pregnant woman's evaluation of her life during HRP. It includes physical, hedonic, and eudaimonic components. The assessment of well-being in HRP should include all these components.
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Affiliation(s)
- Kobra Mirzakhani
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life style institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Farhad Faridhosseini
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Talaat Khadivzadeh
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
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14
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Polsky S, Garcetti R, Pyle L, Joshee P, Demmitt JK, Snell-Bergeon JK. Continuous Glucose Monitor Use With Remote Monitoring Reduces Fear of Hypoglycemia in Pregnant Women With Type 1 Diabetes: A Pilot Study. J Diabetes Sci Technol 2020; 14:191-192. [PMID: 31779476 PMCID: PMC7189168 DOI: 10.1177/1932296819890864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sarit Polsky
- Barbara Davis Center, University of
Colorado Anschutz Medical Campus, Aurora, CO, USA
- Sarit Polsky, MD, MPH, University of
Colorado Anschutz Medical Campus, Barbara Davis Center, 1775 Aurora Court, MS
A140, Aurora, CO 80045, USA.
| | - Rachel Garcetti
- Barbara Davis Center, University of
Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Laura Pyle
- Department of Pediatrics, School of
Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Prakriti Joshee
- Barbara Davis Center, University of
Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jamie K. Demmitt
- Barbara Davis Center, University of
Colorado Anschutz Medical Campus, Aurora, CO, USA
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15
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Cataudella S, Lampis J, Agus M, Casula F, Monni G. A Pilot Study of the Relationship Between Pregnancy and Autoimmune Disease: Exploring the Mother's Psychological Process. Front Psychol 2019; 10:1961. [PMID: 31555167 PMCID: PMC6722214 DOI: 10.3389/fpsyg.2019.01961] [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: 06/12/2019] [Accepted: 08/09/2019] [Indexed: 11/13/2022] Open
Abstract
Autoimmune disease mainly affects women in their reproductive years and has a significant impact on childbearing. Pregnancy can induce an improvement of the mother's symptomatology in some diseases such as rheumatoid arthritis while exacerbating or having no effect on other autoimmune diseases as multiple sclerosis (Borchers et al., 2010). This uncertainty can affect the process of psychological reorganization, which leads to the achievement of a maternal identity. The quality of the mother-fetus emotional bond is considered particularly relevant for the subsequent attachment relationship and the psychological development of the infant (Ammaniti et al., 2013). In the last trimester of pregnancy, 15 women with different autoimmune diseases were interviewed using the IRMAG-R (Ammaniti and Tambelli, 2010). They also completed a battery comprising: PAI (Della Vedova et al., 2008); MAAS (Busonera et al., 2016); DAS (Gentili et al., 2002); PBI (Scinto et al., 1999); MSPSS (Prezza and Principato, 2002); DERS, (Giromini et al., 2012); CES-D (Fava, 1983); HCR-TS (Bova et al., 2012). All interviews were audiotaped, transcribed verbatim, and analyzed by Atlas.ti. The results show that women with autoimmune disease were ambivalent toward pregnancy, had high levels of depression, had difficulties in recognizing physical and psychological changes, and had difficulties in imagining the child. These are considered risk factors that could negatively affect the postnatal mother-infant relationship. These results focus on the importance of early multidisciplinary interventions that can support expectant women when they show signs of relationship difficulties with their infants prior to his/her birth.
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Affiliation(s)
- Stefania Cataudella
- Department of Pedagogy, Psychology, Philosophy, Faculty of Humanities, University of Cagliari, Cagliari, Italy
| | - Jessica Lampis
- Department of Pedagogy, Psychology, Philosophy, Faculty of Humanities, University of Cagliari, Cagliari, Italy
| | - Mirian Agus
- Department of Pedagogy, Psychology, Philosophy, Faculty of Humanities, University of Cagliari, Cagliari, Italy
| | - Fabiana Casula
- Department of Pedagogy, Psychology, Philosophy, Faculty of Humanities, University of Cagliari, Cagliari, Italy
| | - Giovanni Monni
- Department of Prenatal Diagnosis and Fetal Therapy, Ospedale Microcitemico, Cagliari, Italy
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16
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Carlsson IM, Berg M, Adolfsson A, Sparud-Lundin C. Reprioritizing life: a conceptual model of how women with type 1 diabetes deal with main concerns in early motherhood. Int J Qual Stud Health Well-being 2018; 12:1394147. [PMID: 29092688 PMCID: PMC5678444 DOI: 10.1080/17482631.2017.1394147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: Becoming a mother is related to increased demands for women with type 1 diabetes mellitus, and more research is needed to identify their needs for support in everyday living. Thus, the aim of this study was to explore the main concerns in daily life in early motherhood for women with type 1 diabetes and how they deal with these concerns. Method: A grounded theory study was conducted in which 14 women with type 1 diabetes were interviewed individually 7 to 17 months after childbirth. Results: A conceptual model was identified with the core category “reprioritizing life”, and three related categories: adjusting to motherhood, taking command of the diabetes, and seeking like-minded women. Becoming a mother was a turning point towards a greater awareness and acceptance of prioritizing diabetes management and health, and thus, life. There was a gap in provision of diabetes care after birth and during the time of early motherhood compared with during pregnancy. Conclusions: Healthcare contacts already planned before delivery can promote person-centred care during the whole period from pregnancy to motherhood. Moreover, providing alternative sources for health information and peer support could improve the life situation during early motherhood.
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Affiliation(s)
- Ing-Marie Carlsson
- a School of Health and Welfare, Department of Health and Nursing , Halmstad University , Halmstad , Sweden
| | - Marie Berg
- b Centre for Person-Centered Care (GPCC) , Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.,c Department of Obstetrics and Gynecology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | | | - Carina Sparud-Lundin
- b Centre for Person-Centered Care (GPCC) , Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
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17
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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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19
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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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20
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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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Carrasco Falcón S, Vega Guedes B, Alvarado-Martel D, Wägner AM. Preconception care in diabetes: Predisposing factors and barriers. ACTA ACUST UNITED AC 2018; 65:164-171. [PMID: 29301729 DOI: 10.1016/j.endinu.2017.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/02/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Preconception care has been shown to decrease the risk of pregnancy-related complications in women with diabetes, but many women do not plan their pregnancies. Our aim was to identify the associated factors and barriers related to involvement of these women in preconception care. MATERIAL AND METHODS Fifty women with pregestational diabetes (28 with type 1 diabetes) and 50 non-diabetic pregnant women were consecutively enrolled at our hospital. They completed a questionnaire, and their medical histories were reviewed. RESULTS All 33 patients with diabetes who received preconception care had a similar current age (34.3±5.3 years) and age at diagnosis (20.3±11.3) than those with no preconception care (n=17) (31.8±5.3 and 19.1±10.6 years respectively; P>.1), but were more frequently living with their partners (97% vs. 70.6%; P=.014), employed (69.7% vs. 29.4%; P=.047), and monitored by an endocrinologist (80.6% vs. 50%; P=.034), had more commonly had previous miscarriages (78.6% vs. 10%; P=.001), and knew the impact of diabetes on pregnancy (87.5% vs. 58.8%; P=.029). The frequency of preconceptional folic acid intake was similar in pregnant women with and without diabetes (23.8% vs. 32%; P>.1). CONCLUSIONS Preconception care of diabetic patients is associated to living with a partner, being employed, knowing the risks of pregnancy-related complications, having previous miscarriages, and being monitored by an endocrinologist. Pregnancy planning is infrequent in both women with and without diabetes.
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Affiliation(s)
| | - Begoña Vega Guedes
- Servicio de Ginecología y Obstetricia, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las Palmas de Gran Canaria, España; Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Dácil Alvarado-Martel
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España; Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Ana M Wägner
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España; Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las Palmas de Gran Canaria, España.
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Lee SM, Park HJ. Relationship among Emotional Clarity, Maternal Identity, and Fetal Attachment in Pregnant Women with Gestational Diabetes Mellitus. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2017; 23:99-108. [PMID: 37684889 DOI: 10.4069/kjwhn.2017.23.2.99] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/11/2017] [Accepted: 04/19/2017] [Indexed: 09/10/2023] Open
Abstract
PURPOSE The purpose of this study was to examine the relationship among emotional clarity in emotional intelligence, maternal identity, and fetal attachment to measure how emotional clarity and maternal identity impact on fetal attachment and to determine mediating effects of maternal identity in pregnant women at the time of diagnosis with gestational diabetes mellitus (GDM). METHODS This study used a correlational survey design. 88 pregnant women with GDM completed a study questionnaire of emotional clarity, maternal identity, and fetal attachment immediately after the diagnosis of GDM. Data were analyzed Mann-Whitney U test, and ANOVA with Duncan test, Pearson correlation, three-step regressions to test mediating effect, and Sobel test. RESULTS The emotional clarity was positively related with maternal identity and fetal attachment. It affected maternal identity with 21.9% of explained variance. The emotional clarity and the maternal identity were significant predictors of fetal attachment by 57.7% of explained variance. The maternal identity mediated the relationship between emotional clarity and fetal attachment. CONCLUSION The results suggest that a nursing program to enhance the emotional clarity and the maternal identity needs to be developed as an effective strategy to improve fetal attachment.
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Ross GP, Falhammar H, Chen R, Barraclough H, Kleivenes O, Gallen I. Relationship between depression and diabetes in pregnancy: A systematic review. World J Diabetes 2016; 7:554-571. [PMID: 27895824 PMCID: PMC5107715 DOI: 10.4239/wjd.v7.i19.554] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/20/2016] [Accepted: 06/14/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To systematically review the literature on women with both diabetes in pregnancy (DIP) and depression during or after pregnancy. METHODS In this systematic literature review, PubMed/MEDLINE and EMBASE were searched (13 November 2015) using terms for diabetes (type 1, type 2, or gestational), depression, and pregnancy (no language or date restrictions). Publications that reported on women who had both DIP (any type) and depression or depressive symptoms before, during, or within one year after pregnancy were considered for inclusion. All study types were eligible for inclusion; conference abstracts, narrative reviews, nonclinical letters, editorials, and commentaries were excluded, unless they provided treatment guidance. RESULTS Of 1189 articles identified, 48 articles describing women with both DIP and depression were included (sample sizes 36 to > 32 million). Overall study quality was poor; most studies were observational, and only 12 studies (mostly retrospective database studies) required clinical depression diagnosis. The prevalence of concurrent DIP (any type) and depression in general populations of pregnant women ranged from 0% to 1.6% (median 0.61%; 12 studies). The prevalence of depression among women with gestational diabetes ranged from 4.1% to 80% (median 14.7%; 16 studies). Many studies examined whether DIP was a risk factor for depression or depression was a risk factor for DIP. However, there was no clear consensus for either relationship. Importantly, we found limited guidance on the management of women with both DIP and depression. CONCLUSION Given the increasing prevalence of diabetes and depression, high-quality research and specific guidance for management of pregnant women with both conditions are warranted.
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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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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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Bień A, Rzońca E, Kańczugowska A, Iwanowicz-Palus G. Factors Affecting the Quality of Life and the Illness Acceptance of Pregnant Women with Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010068. [PMID: 26703697 PMCID: PMC4730459 DOI: 10.3390/ijerph13010068] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 12/09/2015] [Accepted: 12/11/2015] [Indexed: 12/16/2022]
Abstract
The paper contains an analysis of the factors affecting the quality of life (QoL) and the illness acceptance of diabetic pregnant women. The study was performed between January and April, 2013. It included 114 pregnant women with diabetes, hospitalized in the High Risk Pregnancy Wards of several hospitals in Lublin, Poland. The study used a diagnostic survey with questionnaires. The research instruments used were: The WHOQOL-Bref questionnaire and the Acceptance of Illness Scale (AIS). The women’s general quality of life was slightly higher than their perceived general health. A higher quality of life was reported by women with a very good financial standing, very good perceived health, moderate self-reported knowledge of diabetes, and also by those only treated with diet and stating that the illness did not interfere with their lives (p < 0.05). Women with a very good financial standing (p < 0.009), high self-reported health (p < 0.002), and those treated with by means of a diet (p < 0.04) had a higher acceptance of illness. A higher acceptance of illness contributes to a higher general quality of life and a better perception of one’s health.
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Affiliation(s)
- Agnieszka Bień
- Independent Obstetric Skills Unit, Faculty of Health Sciences, Medical University of Lublin, 4 Staszica St., 20-081 Lublin, Poland.
| | - Ewa Rzońca
- Independent Obstetric Skills Unit, Faculty of Health Sciences, Medical University of Lublin, 4 Staszica St., 20-081 Lublin, Poland.
| | - Angelika Kańczugowska
- Neonatology Ward, Independent Public Teaching Hospital No. 4 in Lublin, 8 Jaczewskiego St., 20-954 Lublin, Poland.
| | - Grażyna Iwanowicz-Palus
- Independent Obstetric Skills Unit, Faculty of Health Sciences, Medical University of Lublin, 4 Staszica St., 20-081 Lublin, Poland.
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Experiences of First-Time Mothers With Persistent Pelvic Girdle Pain After Childbirth: Descriptive Qualitative Study. Phys Ther 2015; 95:1354-64. [PMID: 25929535 DOI: 10.2522/ptj.20150088] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/19/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pelvic girdle pain (PGP) is common during pregnancy and negatively affects women's lives. When PGP persists after the birth, the way it affects women's lives may change, particularly for first-time mothers as they adjust to motherhood, yet the experiences of women with persistent PGP remain largely unexplored. OBJECTIVES The objective of this study was to explore primiparous women's experiences of persistent PGP and its impact on their lives postpartum, including caring for their infant and their parental role. DESIGN This was a descriptive qualitative study. METHODS Following institution ethical approval, 23 consenting primiparous women with PGP that had started during pregnancy and persisted for at least 3 months postpartum participated in individual interviews. These interviews were recorded, transcribed, and analyzed using thematic analysis. RESULTS Four themes emerged: (1) "Putting up with the pain: coping with everyday life," in which women put up with the pain but had to balance activities and were grateful for support from family and friends to face everyday challenges; (2) "I don't feel back to normal," in which women's feelings of physical limitations, frustration, and a negative impact on their mood were described; (3) "Unexpected," in which persistent symptoms were unexpected for women due to a lack of information given about PGP; and (4) "What next?," in which the future of women's symptoms was met with great uncertainty, and they expressed worry about having another baby. CONCLUSION For first-time mothers, having persistent PGP postpartum affects their daily lives in many ways. These findings provide important information for health care providers, which will improve their understanding of these women's experiences, will enhance rapport, and can be used to provide information and address concerns to optimize maternity care during pregnancy and beyond.
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Breastfeeding practices in women with type 1 diabetes: A discussion of the psychosocial factors and policies in Sweden and Australia. Women Birth 2015; 28:71-5. [PMID: 25435074 DOI: 10.1016/j.wombi.2014.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 10/30/2014] [Accepted: 11/03/2014] [Indexed: 11/20/2022]
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Hypoglycemia-Induced Hemiparesis in a Diabetic Woman after Childbirth. Case Rep Neurol Med 2015; 2015:210613. [PMID: 25984373 PMCID: PMC4423000 DOI: 10.1155/2015/210613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/12/2015] [Indexed: 11/17/2022] Open
Abstract
A 24-year-old female with type 1 diabetes mellitus presented with hemiparesis induced by hypoglycemia. She was hospitalized because she has noticed a weakness of her right hand and leg three days after childbirth. On physical examination she had an expressive dysphasia and right side hemiparesis with facial drop. Hypoglycemia is rarely associated with hemiparesis and it is often overlooked, especially when it happens in patients at higher risk of other diseases frequently associated with hemiparesis. Although sporadical cases of hypoglycemia-induced hemiparesis were reported, the clear pathophysiology behind this is not well determined. However, any individual case is important in order to increase the awareness of hypoglycemia as an important etiology of this condition.
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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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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: 15] [Impact Index Per Article: 1.4] [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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