Experiences of stigma, psychological distress, and facilitative coping among pregnant people with gestational diabetes mellitus

Quality of Life in Women With Gestational Diabetes Mellitus and Treatment Satisfaction Upon Intermittently Scanned Continuous Glucose Monitoring

BACKGROUND

To assess the quality of life (QoL) and treatment satisfaction with intermittently-scanned continuous glucose monitoring (isCGM) in women with gestational diabetes mellitus (GDM).

METHODS

This prospective observational study included 189 women with GDM who completed the Korean version of the Audit of Diabetes-Dependent Quality of Life Questionnaire (K-ADDQoL). Among them, 25 women who utilized isCGM between gestational weeks 30 and 34 completed the Korean version of the Diabetes Treatment Satisfaction Questionnaire change version (K-DTSQc) to evaluate their satisfaction with isCGM during pregnancy.

RESULTS

GDM had a negative impact on the perceived QoL in 89.4% of the women. All 19 domains of the K-ADDQoL were adversely influenced by GDM, with the most significant impact on the freedom to eat (weighted impact score, -6.98 ± 2.49, P < 0.001) and the least impact on the sex life (-0.25 ± 0.80, P = 0.008). Younger women and those treated with insulin perceived themselves as being more affected in their QoL due to GDM. Women perceived to have less effect on their QoL attributed to GDM exhibited higher ΔHbA1c one year after delivery (ΔHbA1c, 0.3 ± 0.4% vs. 0.0 ± 0.4% in less affected vs. more affected women). The utilization of isCGM improved treatment satisfaction (overall satisfaction score, 10.36 ± 9.21, P < 0.001), independent of glycemic control during pregnancy.

CONCLUSION

Although GDM negatively affects the perceived QoL during pregnancy, attentiveness to GDM management may have a positive impact on long-term glycemic control. Moreover, employing isCGM can enhance treatment satisfaction in women with GDM.

Women's views about online communities for gestational diabetes mellitus: A qualitative interview study

PROBLEM AND BACKGROUND

Gestational diabetes mellitus (GDM) is a common medical complication of pregnancy, and the emerging evidence demonstrates how GDM online communities have a positive impact on promoting self-management and improving outcomes. Further analysis of such groups can increase understanding of how peer support in GDM online communities is enabled and enacted.

AIM

To examine women's experiences of GDM online communities on Facebook, their motivations for participation, and perceptions of dynamics within the community.

METHODS

Semi-structured phone interviews were conducted with 28 participants, recruited from an online survey posted in two self-organised Australian GDM Facebook groups.

RESULTS

From our thematic analysis of the interview data, four themes were identified from participants' views about GDM online communities: 'A safe community' encapsulated a desire to be connected with others having similar experiences in a non-judgmental space; 'A supportive and informative group' concerned the need for, and giving of, support, and gaining knowledge; 'An adjunct to healthcare' referred to participants' use of GDM online communities to inform their healthcare experiences; and 'A waiting room' reflected participants' continued involvement in GDM online communities, in part due to future uncertainty.

DISCUSSION AND CONCLUSION

Our findings affirm the value of GDM online communities on Facebook for community, support and information. GDM online communities serve as an adjunct to formal healthcare, augmenting clinic-based appointments and clinical management of GDM, encouraging informed decision-making and self-advocacy. We highlight how, in such spaces, women collaboratively navigate self-management and healthcare.

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 health and healthcare experiences in the years after gestational diabetes or hypertensive disorders of pregnancy

BACKGROUND

Pregnancy complications, such as gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP), affect a significant proportion of women in Australia, with long-term implications for cardiovascular disease (CVD) risk. Despite existing preventive measures, participation in ongoing health monitoring remains low. This study aims to explore women's preferences and experiences regarding preventive healthcare after GDM and HDP, and to identify their unanswered questions about the association between these conditions and future CVD risk.

METHODS

A participatory, qualitative approach was adopted, involving a Lived Experience Expert Group (LEE Group) to plan, conduct, and interpret focus groups with women who had experienced either GDM or HDP. Participants were recruited through health consumer and community organisations and took part in two focus groups conducted via Zoom. The focus groups involved a stimulus presentation about CVD and GDM or HDP, facilitated group discussion about participants' health and healthcare since their pregnancy, and Nominal Group Technique to prioritise participants' questions about their CVD risk. Focus groups were audio recorded and transcripts from each group were analysed thematically. Synthesised Member Checking was used to verify the trustworthiness of findings.

RESULTS

Twelve women participated in the focus groups, with distinct themes emerging from the GDM and HDP focus groups. Participants were previously unaware of the association between their pregnancy complication and increased risk of future CVD and wished to know more. Three themes were generated from the GDM focus groups: 'a distressing diagnosis'; 'degrees of diabetes'; and 'balancing motherhood and self-care'. Two themes were generated from the HDP focus groups: 'women's concerns were dismissed' and 'wanting follow up at the right time and with the right person'. The 'top ten' questions from each group focussed on improving maternity care, preventing CVD, and (for the HDP group) concerns beyond CVD.

CONCLUSIONS

Women's capacity to engage in preventive health after GDM and HDP is influenced by their maternity care experiences and the accessibility of primary care pathways. Future interventions should focus on improving woman-centred maternity care, ensuring seamless transitions to primary care, and addressing the social determinants of health for new mothers.

Research on the application effect of self-transcendence nursing model in patients with gestational diabetes mellitus: a randomised controlled trial

BACKGROUND

Gestational diabetes mellitus is hyperglycemia in special populations (pregnant women), however gestational diabetes mellitus (GDM) not only affects maternal health, but also has profound effects on offspring health. The prevalence of gestational diabetes in my country is gradually increasing.

OBJECTIVE

To study the application effect of self-transcendence nursing model in GDM patients.

METHODS

One hundred fourteen GDM patients undergoing prenatal examination in Hai'an People's Hospital from January 2019 to November 2021 were selected and divided into two groups of 57 cases respectively according to the principle of random single blind. The patients in the control group should receive pregnancy health care under the routine nursing mode, while those in the observation group should receive pregnancy health care under the self-transcendence nursing mode. Then, we would compare the insulin utilization rate, admission before delivery, gestational weeks, delivery outcome and neonatal conditions between the two groups, examine the changes of blood glucose related indexes in the two groups and evaluate the differences between the two groups' Diabetes Distress Scale (DDS) scores and Chinese Versions of Diabetes Management Self-efficacy Scale (C-DMSES) scores.

RESULTS

The number of hospital admissions (1.12 ± 0.31) and the hospital stay (7.54 ± 1.45) days in the observation group were less than those in the control group (1.56 ± 0.42) and (10.23 ± 2.32) days. There was no difference between the two groups after statistical analysis of gestational weeks and insulin utilization rate (P > 0.05). After the intervention, the total DDS score and emotional burden, doctor/life law/interpersonal relationship related distress score of GDM in the two groups were lower than those before the intervention, while the scores of healthy diet, regular exercise, regular monitoring of blood glucose and medication compliance in C-DMSES were higher than those before the intervention. In addition, the improvements of overall DDS scores and C-DMSES scores of GDM in the observation group were significantly better than those in the control group, so there was statistical significance (P < 0.05). In terms of the pregnancy outcomes and neonatal conditions, the rates of premature delivery and neonatal delivery in the observation group were higher than those in the control group, and there was no difference (P > 0.05) in other aspects of pregnancy outcomes and neonatal conditions.

CONCLUSION

Self-transcendence nursing mode intervention can improve blood sugar, reduce psychological distress, and improve self-efficacy in GDM patients, thereby reducing the rate of pregnancy-induced hypertension and premature birth.

Characterizing sociodemographic disparities and predictors of Gestational Diabetes Mellitus among Asian and Native Hawaiian or other Pacific Islander pregnant people: an analysis of PRAMS data, 2016-2022

BACKGROUND

Gestational Diabetes Mellitus (GDM) affects between 2 and 10% of pregnancies in the United States, with trends of increasing prevalence and a significant amount of variability across race and ethnicity, maternal age, and insurance status. Asian and Native Hawaiian or Other Pacific Islanders (NHOPI) have been documented to have a higher prevalence and risk of developing GDM compared to non-Hispanic white populations and have been under-studied in health disparities research.

METHODS

Using data from the Pregnancy Risk Assessment Monitoring System (PRAMS) 2016-2022 surveys, we conducted analyses for the overall PRAMS sample as well as within-group analyses among participants who identify as Asian and NHOPI to identify risk factors for GDM. Descriptive statistics were also collected in the Asian and NHOPI subsample, stratified by Asian and NHOPI ethnicity. Bivariate analyses were performed to explore the relationship between potential GDM risk factors among the overall analytic sample and within the Asian and NHOPI subsample, and multivariable logistic regression was used to investigate potential predictors of GDM.

RESULTS

Asian and NHOPI ethnicities differed by prevalence of GDM at 17.2%, 19.56%, 10.8%, 10.71%, and 18.49% for Chinese, Filipino, Japanese, Native Hawaiian/Other Pacific Islander, and Other Asian, respectively. Compared to White individuals (reference group), the odds of GDM were higher for Asian and Native Hawaiian/Other Pacific Islander individuals in the adjusted model (adjusted odds ratio (aOR) = 2.19, 95% CI: 2.62-2.9). Native mothers also demonstrated significantly elevated odds (aOR = 1.48, 95% CI: 1.4-1.6), while Mixed-race individuals exhibited slightly increased odds (OR = 1.22, 95% CI: 1.14-1.29). The findings revealed notable variability in GDM risk factors across ANHOPI subgroups. Obesity emerged as a consistent and strong predictor of GDM across all groups, while other factors such as interpersonal violence exposure and prenatal depression demonstrated limited or subgroup specific effects.

CONCLUSION

This analysis of 2016 to 2022 PRAMS data illustrated significant variations of GDM predictors between the general population and the Asian and NHOPI population, as well as differences between Asian and NHOPI ethnicities.

'It's so heavy on my mind': The lived experience of diabetes in pregnancy and postpartum mother and infant lifestyle

BACKGROUND

Diabetes in pregnancy is associated with short and long-term adverse health outcomes for mothers and babies. The condition disproportionately impacts Pacific, Maaori, and Indian pregnancies. Those with diabetes are offered intensive support during pregnancy, but in many centres, no additional support following birth beyond routine care. The aim of this study was to determine the postpartum needs for mothers and whaanau (family) impacted by diabetes in pregnancy, to inform co-design of a new service to improve metabolic and developmental outcomes for infants.

METHODS

Pregnancies complicated by diabetes were identified using a local diabetes registry. Mothers with a diagnosis of GDM or T2DM and gave birth between January 2022 -June 2022 were eligible for the study. A total of 19 parents (18 mothers, 1 father) were interviewed. Participants primarily identified as Maaori (6), Pacific (6), Indian (3), Asian (2), and New Zealand European (2). Interviews took place between December 2022 and February 2023, between 5-13 months post-pregnancy. Interviews facilitated by an externally contracted local Pacific mother, with a professional background in social work were conducted using Koorero and Talanoa, Maaori and Pacific methods of qualitative data collection, to capture the lived experiences of participants. A multidisciplinary group reviewed and coded interview transcripts. Themes were presented back to participants and stakeholders for feedback and refinement. Four over-arching themes were illustrated with exemplar quotes.

RESULTS

Four themes described the importance of 1) Finding a balance between what is "best practice" and what is best for me, my baby and my whaanau, 2) The need for individualised and culturally appropriate care, 3) Centrality of whaanau and family to the pregnancy and postpartum journey, 4) The pervasive negative impact of diabetes on taha hinegaro (well-being) beyond childbirth.

CONCLUSION

People who are affected by diabetes in pregnancy have ongoing physical, psychological, and social needs. A holistic, whaanau-centred approach is required to ensure optimal health and well-being outcomes of mothers, infants and whaanau. The findings of this study will inform a new targeted model of care for infants and whaanau affected by diabetes in pregnancy.

The influence of Chinese culture and customs on the beliefs and health-related behaviours of Chinese women with gestational diabetes mellitus: A qualitative study

OBJECTIVE

The study aimed to explore the influence of Chinese culture and customs on the beliefs and health-related behaviours of Chinese women with gestational diabetes mellitus (GDM).

METHODS

This descriptive qualitative study conducted semi-structured interviews with 15 Chinese women between November 2022 and January 2023. The interview data were analysed using thematic analysis.

RESULTS

Three major themes are found: (1) beliefs in health, (2) beliefs in illness and GDM and (3) beliefs in health-related behaviours. They worried about the negative effects of GDM on the infant and family, so they actively sought medical advice to maintain health. However, it is challenging for them to balance adhering to healthcare professionals' advice and avoiding practical difficulties in the impact of the Chinese sociocultural context.

CONCLUSION

This study emphasizes the influence of Chinese culture and customs on the beliefs and health-related behaviours of women with GDM. Healthcare providers should recognize the influence of Chinese culture, customs and beliefs on women with GDM and their families, in order to provide individualized education to help them maintain health-related behaviours.

Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations

People with diabetes often encounter stigma (ie, negative social judgments, stereotypes, prejudice), which can adversely affect emotional, mental, and physical health; self-care, access to optimal health care; and social and professional opportunities. To accelerate an end to diabetes stigma and discrimination, an international multidisciplinary expert panel (n=51 members, from 18 countries) conducted rapid reviews and participated in a three-round Delphi survey process. We achieved consensus on 25 statements of evidence and 24 statements of recommendations. The consensus is that diabetes stigma is driven primarily by blame, perceptions of burden or sickness, invisibility, and fear or disgust. On average, four in five adults with diabetes experience diabetes stigma and one in five experience discrimination (ie, unfair and prejudicial treatment) due to diabetes, such as in health care, education, and employment. Diabetes stigma and discrimination are harmful, unacceptable, unethical, and counterproductive. Collective leadership is needed to proactively challenge, and bring an end to, diabetes stigma and discrimination. Consequently, we achieved unanimous consensus on a pledge to end diabetes stigma and discrimination.

Nutrients as Risk Factors and Treatments for Gestational Diabetes

Gestational diabetes (GDM), traditionally defined as any form of glucose intolerance first detected in pregnancy [...].