Postnatal experiences, knowledge and perceptions of women with gestational diabetes

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

PROBLEM

Models of care for women with gestational diabetes mellitus (GDM) have evolved in an ad hoc way and do not meet women's needs.

BACKGROUND

GDM affects 50,000 Australian women per annum with prevalence quadrupling in the last ten years. Many health services are struggling to provide a quality service. People with diabetes are calling for care that focuses on their wellbeing more broadly.

AIM

To examine the holistic (emotional, social, economic, and spiritual) care needs of women with GDM.

METHODS

Qualitative and mixed-methods studies capturing the healthcare experiences of women with GDM were searched for in CINAHL, Medline, Web of Science and Scopus. English-language studies published between 2011 and 2023 were included. Quality of studies was assessed using Crowe Critical Appraisal Tool and NVIVO was used to identify key themes and synthesise data.

FINDINGS

Twenty-eight studies were included, representing the experiences of 958 women. Five themes reflect women's holistic needs through their journey from initial diagnosis to postpartum: psychological impact, information and education, making change for better health, support, and care transition.

DISCUSSION

The biomedical, fetal-centric model of care neglects the woman's holistic wellbeing resulting in high levels of unmet need. Discontinuity between tertiary and primary services results in a missed opportunity to assist women to make longer term changes that would benefit themselves (and their families) into the future.

CONCLUSIONS

The provision of holistic models of care for this cohort is pivotal to improving clinical outcomes and the experiences of women with GDM.

Prevalence of Sex-Specific Cardiovascular Disease Risk Factors, Medical Risk, and Engagement in Health-Promoting Behaviours in Premenopausal Females

Background

Several sex-specific risk factors (SS-RFs) increase a women's risk for cardiovascular disease (CVD) but are often overlooked during risk assessment. The purpose of this study was to identify the prevalence of SS-RFs and assess CVD risk, knowledge, perceptions and behaviours in premenopausal Canadian women.

Methods

An online survey was distributed across Canada to premenopausal biological females (19-49 years of age). The survey gathered demographics, medical history, engagement in health-promoting behaviours, and knowledge and perceptions of CVD risk. CVD risk was calculated using medical risk and SS-RFs were tabulated from medical history.

Results

A total of 2559 participants (33 ± 8 years) completed the survey. The majority of our sample (82%) was classified as low medical risk. Of those classified as low risk, 35% had at least 1 SS-RF. Of high-risk individuals, 70% underestimated their risk, 21% of whom perceived themselves as low risk. Engagement in health behaviours was suboptimal. Knowledge of traditional CVD risk factors and prevention was relatively high; however, less than one-half were aware of SS-RFs such as early menopause (39.4%).

Conclusions

Considering both traditional and SS-RFs, 47% of premenopausal Canadian women may be at risk for developing CVD. Of those deemed low medical risk for developing CVD, more than one-third reported having at least 1 SS-RF. Canadian women have poor knowledge of the risks associated with SS-RFs, lack sufficient awareness of the need for prevention of CVD, and are not engaging in sufficient health-promoting behaviours to mitigate future CVD risk.

Predicting lymphedema self-management behaviours in breast cancer patients: A structural equation model with the Integrated Theory of Health Behaviour Change

AIMS

To explore predictors of lymphedema self-management behaviours among Chinese breast cancer survivors based on the Integrated Theory of Health Behaviour Change, and to clarify the interrelationship among these variables.

DESIGN

Further analysis of a multicentre cross-sectional and survey-based study.

METHODS

A total of 586 participants with breast cancer were recruited from December 2021 to April 2022 in different cities in China. We used self-reported questionnaires to collect data. Descriptive analysis, bivariate analysis and structural equation model were performed.

RESULTS

The Integrated Theory of Health Behaviour Change is suitable for predicting lymphedema self-management behaviours. The final structural model showed good model fit. Social support, self-efficacy and lymphedema knowledge positively affected lymphedema self-management behaviours, directly and indirectly. Self-regulation acted as a crucial mediator between these variables and self-management. The direct path between social support and self-regulation was not significant. Lymphedema knowledge and social support also influenced self-management via illness perception, self-efficacy and self-regulation, sequentially. These variables explained 55.9% of the variance in lymphedema self-management behaviours.

CONCLUSIONS

The modified model based on the Integrated Theory of Health Behaviour Change fitted well in predicting lymphedema self-management behaviours among breast cancer patients. Lymphedema knowledge, illness perception, self-efficacy, social support and self-regulation directly and indirectly influenced lymphedema self-management behaviours.

IMPACT

This study provides a theoretical basis for the assessment and interventions of lymphedema self-management behaviours in breast cancer patients. Lymphedema self-management behaviours should be assessed regularly and comprehensively, taking these predictors into consideration to identify potential barriers. Further research is needed to explore effective interventions integrating these significant predictors.

REPORTING METHOD

This study was reported following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contributed to the design or conduct of the study, analysis or interpretation of the data, or in the preparation of the manuscript. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: This study focused on identifying and predicting mechanism of self-management based on a theory of behaviour change. The results can be applied among patients with other chronic diseases or high-risk populations, and inspire the assessment and interventions facilitating self-management behaviours.

STUDY REGISTRATION

This study was registered as an observational study at Chinese Clinical Trial Registry: http://www.chictr.org.cn (ChiCTR2200057084).

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

For breast cancer patients with poor lymphedema self-management behaviour, attention should be raised among nurses and involved healthcare staffs that lymphedema self-management is multi-faced. Strategies targeted at improving social support, self-regulation, knowledge, self-efficacy and illness perception should be also addressed in lymphedema self-management programs, to facilitate more effective improvement of lymphedema self-management behaviours.

Women's needs for lifestyle risk reduction engagement during the interconception period: a scoping review

BACKGROUND

Unhealthy lifestyle is responsible for many chronic conditions, and antenatal engagement with women about lifestyle behaviours can be too late to prevent some adverse pregnancy outcomes and subsequent childhood risks. To reduce the risk of future adverse outcomes, the interconception period is an opportunity to implement positive health changes. The aim of this scoping review was to explore women's needs for lifestyle risk reduction engagement during the interconception period.

METHODS

The JBI methodology guided our scoping review. Six databases were searched for peer-reviewed, English-language research papers published between 2010 and 2021 on topics including perceptions, attitudes, lifestyle, postpartum, preconception and interconception. Title-abstract and full text screening was independently undertaken by two authors. Included papers' reference lists were searched to find additional papers. The main concepts were then identified using a descriptive and tabular approach.

RESULTS

A total of 1734 papers were screened and 33 met our inclusion criteria. Most included papers (82%, n=27) reported on nutrition and/or physical activity. Papers identified interconception through postpartum and/or preconception. Women's self-management needs for lifestyle risk reduction engagement during interconception included: informational needs, managing competing priorities, physical and mental health, self-perception and motivation, access to services and professional support, and family and peer networks.

CONCLUSIONS

There is a range of challenges for women to engage in lifestyle risk reduction during interconception. To enable women's preferences for how lifestyle risk reduction activities can be enacted, issues including childcare, ongoing and tailored health professional support, domestic support, cost and health literacy need to be addressed.

"It feels like medically promoted disordered eating": The psychosocial impact of gestational diabetes mellitus in the perinatal period

BACKGROUND

The global prevalence of gestational diabetes mellitus (GDM) is increasing, and it can significantly impact women's psychosocial outcomes in the perinatal period. The aim of this study was to explore the psychosocial impacts including experiences of support for women with GDM in the antenatal and postnatal period.

METHODS

Semi-structured individual interviews were conducted with women (n = 33) living in the UK, who were either pregnant and recently diagnosed with GDM or had a previous GDM diagnosis within the past three years. Interviews were recorded, transcribed, and analysed using reflexive thematic analysis.

FINDINGS

Analysis revealed six themes: 1. Diagnostic related frustration; 2. Impact on mental health; 3. The medicalisation of eating; 4. Losing agency to gain control; 5. Sourcing networks of support; 6. Current pregnancy; and future reproductive health. Each theme provides a unique insight into the experiences and psychological strain associated with GDM. From confusion and frustration at diagnosis, to the profound knock-on impact a diagnosis, associated lifestyle changes and medical appointments had on women's mental health, and the perceived medicalisation of their eating behaviours and patterns.

CONCLUSION

Given the increasing prevalence of GDM and its wide-ranging psychosocial impacts, this study emphasises the need for healthcare professionals to consider the potential implications of GDM on women's psychosocial outcome, and to consider alternative support options outside of the medical system, such as peer support.

Facilitators and barriers to attending postpartum screening in women with a recent pregnancy complicated by gestational diabetes mellitus: a qualitative study

OBJECTIVE

Pregnant women with gestational diabetes mellitus (GDM) are 50% more likely to develop type II diabetes (T2D) within 6 months to 2 years after giving birth. Therefore, international guidelines recommend it is best practice for women diagnosed with GDM to attend screening for T2D 6-12 weeks postpartum and every 1-3 years thereafter for life. However, uptake of postpartum screening is suboptimal. This study will explore the facilitators of and barriers to attending postpartum screening for T2D that women experience.

STUDY DESIGN

This was a prospective qualitative cohort study using thematic analysis.

METHODS

A total of 27 in-depth, semistructured interviews were conducted over the telephone with women who had recent GDM. Interviews were recorded and transcribed, and data were analysed using thematic analysis.

RESULTS

Facilitators of and barriers to attending postpartum screening were identified at three different levels: personal, intervention, and healthcare systems level. The most common facilitators identified were concern for their own health and having the importance of screening explained to them by a health professional. The most common barriers identified were confusion over the test and COVID-19.

CONCLUSION

This study identified several facilitators of and barriers to attending postpartum screening. These findings will help to inform research and interventions for improving rates of attendance at postpartum screening to reduce the subsequent risk of developing T2D.

The stigma associated with gestational diabetes mellitus: A scoping review

BACKGROUND

Gestational diabetes mellitus (GDM) affects an increasing number of pregnant women globally. Although studies have identified psychosocial ramifications associated with GDM, stigma in the form of experienced discrimination and self-blame and its consequences have received limited attention. Our objective was to examine the current evidence on stigma, as experienced among women with GDM, including the potential adverse consequences hereof.

METHODS

A scoping review was conducted with citations retrieved from the databases MEDLINE, CINAHL, EMBASE and, PsycINFO. Studies published before 15 June 2022, when the search was conducted, were included.

FINDINGS

We identified 1388 citations and included 44 in the review. We found that women with GDM may experience stigma in the form of overt discrimination from healthcare personnel and relatives, and in the form of internalised stigma, such as guilt and shame. Identified consequences include avoidance of screening, not following dietary recommendations nor reporting blood glucose readings, social isolation, and poor mental wellbeing. No estimates of stigma prevalence were identified.

INTERPRETATION

Existing evidence shows that women with GDM report stigma, which may affect both their mental and physical health. Further investigations into the prevalence of stigma and long-term consequences of stigma are much needed.

FUNDING

The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Barriers to and enablers of type 2 diabetes screening among women with prior gestational diabetes: A systematic review update and qualitative synthesis applying the Theoretical Domains Framework

AIMS

Women with prior gestational diabetes have nearly 10 times the risk of developing type 2 diabetes. Postpartum screening for type 2 diabetes is recommended for early diagnosis and management, yet uptake is low. This work updates a previous systematic review and advances it through the application of the Theoretical Domains Framework (TDF) to synthesise personal-level factors impacting type 2 diabetes screening and the Capability, Opportunity, Motivation-Behaviour model (COM-B), to develop messaging recommendations for use in clinical practice and screening promotion interventions.

METHODS

We searched seven academic databases from September 2017 (prior review) to April 2021, reference lists and grey literature. Two reviewers independently screened articles against inclusion criteria (qualitative studies exploring factors impacting postpartum diabetes screening, any language) and extracted data. Using an inductive-deductive model, we coded determinants to the TDF and mapped onto the COM-B model.

RESULTS

We identified 38 eligible papers from 34 studies (N = 1291 participants). Most (71%) reported sample sizes of N ≥ 16. The ratio of barriers to enablers was three to one. Eight key TDF domains were identified. Evidence-based recommendations include addressing knowledge, risk perception, fear of diabetes diagnosis, low prioritisation of personal health and fatalism. The risk of bias was low and confidence in findings was moderate to high. A limitation was conceptual overlap between TDF domains, which we addressed via the study procedure.

CONCLUSIONS

The theoretical categorisation of determinants enables the development of messaging and interventions at the personal level, to promote women's uptake of postpartum type 2 diabetes screening.

Experiences of women with hypertensive disorders of pregnancy: a scoping review

Background

Hypertensive disorders of pregnancy (HDP) constitute one of the leading causes of maternal and perinatal mortality worldwide, and are associated with an increased risk of recurrence and future cardiovascular disease. HDP affect women’s health condition, mode of birth and timing, length of hospital stay, and relationship with their newborn and family, with future life repercussions.

Aims

To explore the experiences of women with HDP from pregnancy to postpartum, and to identify (a) their perceptions and understanding of HDP, (b) their understanding of future health risks, and (c) the possible interventions by healthcare providers.

Methods

A scoping review was conducted following the Joanna Briggs Institute method and in accordance with the PRISMA-ScR checklist. The following databases were searched from 1990 to 2020 (October): MEDLINE (PubMed), EMBASE, Cochrane Library, CINAHL, PsycINFO, and Google Scholar database. The Critical Appraisal Skills Programme (CASP) checklist was used as a guide for the qualitative analysis. Content analysis and synthesis of findings were conducted using Nvivo12.

Results

Of the 1971 articles identified through database searching, 16 articles met the inclusion criteria. After data extraction, content analysis yielded six categories: ‘Life-threatening disorder’, ‘Coping with HDP’, ‘Concerns for baby and challenges of motherhood’, ‘Fear of recurrence and health problems’, ‘Necessity of social and spiritual support’, and ‘Positive and negative experiences in the healthcare context’. Women faced complex difficulties from the long treatment process while transitioning to motherhood.

Conclusion

Our findings revealed the perceptions and understanding of women regarding HDP as a life-threatening disorder to both mothers and their babies which mothers need to cope with. Recovery of physical condition and the long-term psychological effects of HDP on women should be given attention by mothers and HCP to reduce future health risks. Importantly, a lifelong follow-up system is recommended for women with HDP.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04463-y.

Understanding Gestational Diabetes, Future Diabetes Risk, and Diabetes Prevention: A Qualitative Study of Patient, Provider, and Staff Perspectives

Gestational diabetes mellitus (GDM) increases type 2 diabetes risk; however, postpartum diabetes screening rates are low. Using semi-structured interviews and focus groups, this study investigates the understanding of GDM and its relationship to future diabetes risk and diabetes prevention among patients with public or no insurance (n = 36), health care providers (n = 21), and clinic staff (n = 9) from Federally Qualified Health Centers. Five main themes emerged: 1) general understanding of GDM diagnosis with focus on neonatal complications; 2) variable recall of diet, exercise, and weight recommendations; 3) overwhelming medication and self-monitoring routines; 4) short-term focus of type 2 diabetes risk and screening; and 5) limited understanding of all options for diabetes prevention. The results may inform diabetes screening and prevention interventions in primary care settings.

Gestational diabetes mellitus follow-up in Norwegian primary health care: a qualitative study

BACKGROUND

Women with gestational diabetes mellitus (GDM) have a tenfold increased risk of developing diabetes, and a high risk of recurrent GDM. Endorsing the life-course approach aiming to prevent disease and promote health across generations, the Norwegian GDM guideline recommends follow-up in primary care after delivery, with information on the increased risks, lifestyle counselling, and annual diabetes screening. Few reports exist on Norwegian women's experiences of GDM follow-up.

AIM

To elucidate women's experiences with follow-up of GDM in pregnancy and after delivery, and to explore their attitudes to diabetes risk and motivation for lifestyle changes.

DESIGN & SETTING

Qualitative study in primary care in the region of Stavanger, Norway.

METHOD

Semi-structured in-depth interviews were conducted 24-30 months after delivery with 14 women aged 28-44 years, with a history of GDM. Data were analysed thematically.

RESULTS

Most women were satisfied with the follow-up during pregnancy; however, only two women were followed-up according to the guideline after delivery. In most encounters with GPs after delivery, GDM was not mentioned. To continue the healthy lifestyle adopted in pregnancy, awareness of future risk was a motivational factor, and the women asked for tailored information on individual risk and improved support. The main themes emerging from the analysis were as follows: stigma and shame; uncertainty; gaining control and finding balance; and a need for support to sustain change.

CONCLUSION

Women experienced a lack of support for GDM in Norwegian primary care after delivery. To maintain a healthy lifestyle, women suggested being given tailored information and improved support.

Postpartum opportunistic advice in primary care for women who have had gestational diabetes: a qualitative study of health care professionals' views

BACKGROUND

Women who have had gestational diabetes during pregnancy are at very high risk of developing type 2 diabetes later in life, but their understanding of the risks is often limited. In this study we explored the views of health care professionals regarding offering brief opportunistic advice to women after their pregnancy, during unrelated consultations in primary care, relating to reducing diabetes risk.

METHODS

The study took place in three Health Boards in Scotland. We conducted semi-structured one-to-one interviews (either face-to-face or telephone) with two health visitors, three practice nurses, two GPs, two diabetes consultants and two obstetricians. A focus group with five health visitors was also held. A topic guide was followed, covering the feasibility and acceptability of delivering brief opportunistic advice during a routine consultation, the optimal way to identify and recall women with previous gestational diabetes, and the possible content and timing of any such intervention. A thematic approach was used to analyse the qualitative data generated.

RESULTS

The interviews/discussion lasted from 15 to 51 min. There was widespread support from all participants for offering opportunistic advice, and general consensus that health visitors would be best placed to do this as part of the Universal Health Visiting Pathway in Scotland. Thematic analysis generated three significant points of discussion: implications for training of health visitors, the need for a systematic approach to identifying women with gestational diabetes, and the optimal timing of delivery. Despite an already demanding schedule of providing advice and education to women, health visitors were confident that they could offer educational advice, provided that they received appropriate training to do so. However, there would need to be a watertight system for identifying women in their care who had had gestational diabetes. In terms of timing, later visits around 6-8 months after delivery were considered most suitable.

CONCLUSIONS

There is support from health care professionals, and most pertinently from health visitors, that the frequency of routine visits with women during the Universal Health Visiting Pathway programme in Scotland provides potential opportunities for education around future diabetes risk to women who have had gestational diabetes.

Awareness of gestational diabetes mellitus foetal-maternal risks: an Italian cohort study on pregnant women

Background

Gestational diabetes mellitus (GDM) incidence is increasing worldwide. It represents a major risk factor for adverse foetal-maternal outcomes. Awareness among women in regard to GDM-related risks (in particular foetus ones) has been proven to have an impact on compliance with recommendations. Therefore we aimed to evaluate the efficacy of our post-diagnosis counselling, that informs affected women of the GDM related risks for complications, in determining an adequate level of understanding.

Method

This is a cohort study involving 400 women undergoing the 24-28 weeks 75 g oral glucose tolerance test. Two hundred women diagnosed with GDM received the post-diagnosis counselling (treatment group) and two hundred women diagnosed without did not receive any counselling (control group). Both populations were surveyed with a 5 question questionnaire regarding their awareness about GDM foetal-maternal related risks. Their level of education about GDM foetal-maternal related risks, estimated according to the number of correct answers, was scored as: primary (score 0-1), secondary (score 2-3) or tertiary (score 4-5).

Results

Most of the women in the treatment group after receiving the post-diagnosis counselling have demonstrated a secondary level of education 132/200 (66%). Their mean level of awareness was higher in comparison to the control group 2.6 ± 1.8 (SD) versus 2.14 ± 1.8 (SD) p value = 0.012. In particular, they’ve demonstrated to be more aware of the risks for the foetus to become macrosomic (p = 0.004) or to die in utero (p = 0.0001). A high level of education and to have had previous pregnancies positively affected correct answers.

Conclusions

Our post-diagnosis counselling has played a role in improving women awareness about GDM foetal-maternal related risks. Future study will explore the impact of women’s level of awareness on glycaemic control.

Lifestyle and glycemic health 5 years postpartum in obese and non-obese high diabetes risk women

AIM

Women with prior gestational diabetes (GDM) are at increased diabetes risk. This study aimed to assess whether lifestyle is associated with glycemic health of high-risk women 5 years postpartum, taking into account the pre-pregnancy BMI.

METHODS

The RADIEL study enrolled before or in early pregnancy 720 women with pre-pregnancy BMI ≥ 30 kg/m² and/or prior GDM. The follow-up visit 5 years postpartum included questionnaires and measurements of anthropometrics, blood pressure, and physical activity (PA) as well as analyses of glucose metabolism, lipids, and inflammatory markers. We measured body composition (Inbody) and calculated a Healthy Food Intake Index (HFII) from Food Frequency Questionnaires (FFQ). ArmBand measured PA, sedentary time, and sleep. To take into account the diverse risk groups of GDM, we divided the women based on pre-pregnancy BMI over/under 30 kg/m².

RESULTS

Altogether 348 women attended the follow-up. The obese and non-obese women showed similar prevalence of glycemic abnormalities, 13% and 19% (p = 0.139). PA levels were higher among the non-obese women (p < 0.05), except for step count, and their HFII was higher compared to the obese women (p = 0.033). After adjusting for age, education, and GDM history, PA and HFII were associated with glycemic health only among obese women. When both lifestyle factors were in the same model, only PA remained significant. PA associated with other markers of metabolic health also among the non-obese women, excluding HbA1c.

CONCLUSION

Lifestyle 5 years postpartum was associated with better glycemic health only among the obese high-risk women. PA, however, is essential for the metabolic health of all high-risk women.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, http://www.clinicaltrials.com , NCT01698385.

Analysis of spontaneous, user-generated data about gestational diabetes on online forums: implications for diabetes prevention

AIMS

To explore the experiences and perceptions of gestational diabetes mellitus reported by women within online parental-support forums and, specifically, to analyse what women say about a diagnosis of gestational diabetes, their future risk of type 2 diabetes, and lifestyle behaviour for management of gestational diabetes and prevention of type 2 diabetes.

METHODS

The discussion boards of two parenting websites (Mumsnet and Netmums) were searched using the search term 'gestational diabetes or GD' in February 2019. Relevant posts made by users with gestational diabetes on or after 1 January 2017 were retained for analysis. Framework analysis using pre-existing framework from a previous study was used to organize and analyse the data.

RESULTS

A total of 646 posts generated by 282 unique users were included in the analysis. Analysis of the online content identified three important implicit messages that may be being conveyed to readers. The first is that gestational diabetes is not a serious diagnosis that warrants undue concern. Secondly, few users recognized the importance of their own behaviours or lifestyle, with others minimizing personal responsibility or attributing gestational diabetes to non-modifiable factors. Finally, there was a lack of acknowledgment of heightened risk of type 2 diabetes. These three messages will all directly mitigate against the efforts of clinicians (and others) to encourage women with gestational diabetes to improve their lifestyle behaviours in the longer term.

CONCLUSIONS

These findings highlight messages that are being widely disseminated and that are unlikely to support prevention of type 2 diabetes.

Cultural Adaptation, Validation, and Primary Application of a Questionnaire to Assess Intentions to Eat Low-Glycemic Index Foods among Rural Chinese Women

Different lines of evidence indicate that knowledge of low-glycemic index (GI) foods and the practice of eating them play important roles in blood glucose management and preventing T2DM in women with prior gestational diabetes mellitus (GDM). According to the theory of planned behavior (TPB), intention is a critical factor in complying with health-related behaviors. However, an instrument for assessing the intention to eat low-GI foods is lacking in China. We aimed to (1) adapt and validate a Chinese version of the intentions to eat low-GI foods questionnaire (CIELQ) and (2) apply the CIELQ among rural Chinese women to explore the associations between CIELQ scores and glycemic status. A cross-sectional study was conducted on 417 nondiabetic, nonpregnant participants with a history of GDM in Hunan, China. After cultural adaptation and validation, the CIELQ was applied in a target population. Glycemic status, anthropometric variables, dietary intake, and physical activity were measured; a self-developed, standard questionnaire was applied to collect relevant information. The CIELQ showed good internal consistency; model fitness was acceptable based on the confirmatory factor analysis results. Awareness of the glycemic index was low among the study population. TPB factors were found to be associated with each other; education level and parents’ diabetes history were associated with specific factors. The score for instrumental attitude showed a positive association with the risk for a high level of the 2-h 75-g oral glucose tolerance test (odds ratio, OR = 1.330), while the score for perceived behavior control (PBC) showed a negative association with the risk for a high level (OR = 0.793). The CIELQ was determined to be a valid instrument for assessing the intention to eat a low-GI diet among the study population. The awareness of the GI was poor among the study population. The score for instrumental attitude showed a positive association with the risk of a high level on the 2-h 75-g oral glucose tolerance test (OGTT), and the score for PBC showed a negative association with the risk for a high level on OGTT.

Women's experiences of a diagnosis of gestational diabetes mellitus: a systematic review

Background

Gestational diabetes mellitus (GDM) - a transitory form of diabetes induced by pregnancy - has potentially important short and long-term health consequences for both the mother and her baby. There is no globally agreed definition of GDM, but definition changes have increased the incidence in some countries in recent years, with some research suggesting minimal clinical improvement in outcomes. The aim of this qualitative systematic review was to identify the psychosocial experiences a diagnosis of GDM has on women during pregnancy and the postpartum period.

Methods

We searched CINAHL, EMBASE, MEDLINE and PsycINFO databases for studies that provided qualitative data on the psychosocial experiences of a diagnosis of GDM on women across any stage of pregnancy and/or the postpartum period. We appraised the methodological quality of the included studies using the Critical Appraisal Skills Programme Checklist for Qualitative Studies and used thematic analysis to synthesis the data.

Results

Of 840 studies identified, 41 studies of diverse populations met the selection criteria. The synthesis revealed eight key themes: initial psychological impact; communicating the diagnosis; knowledge of GDM; risk perception; management of GDM; burden of GDM; social support; and gaining control. The identified benefits of a GDM diagnosis were largely behavioural and included an opportunity to make healthy eating changes. The identified harms were emotional, financial and cultural. Women commented about the added responsibility (eating regimens, appointments), financial constraints (expensive food, medical bills) and conflicts with their cultural practices (alternative eating, lack of information about traditional food). Some women reported living in fear of risking the health of their baby and conducted extreme behaviours such as purging and starving themselves.

Conclusion

A diagnosis of GDM has wide reaching consequences that are common to a diverse group of women. Threshold cut-offs for blood glucose levels have been determined using the risk of physiological harms to mother and baby. It may also be advantageous to consider the harms and benefits from a psychosocial and a physiological perspective. This may avoid unnecessary burden to an already vulnerable population.

An antenatal wish list: A qualitative systematic review and thematic synthesis of UK dietary advice for weight management and food borne illness

OBJECTIVES

To understand UK women's experiences of antenatal dietary advice for risk of food borne illness and weight gain.

DESIGN

A systematic review and thematic synthesis of peer-reviewed qualitative studies. PubMed, MEDLINE, CINAHL and PMC databases were searched for articles published from January 2008 to June 2018. The search strategy combined terms for pregnancy with terms for body composition, weight change, food safety, nutrition, diet and qualitative terminology. Studies were eligible for inclusion if (1) they explored experiences of implementing advice received during pregnancy for nutrition, physical activity and/or weight gain, and (2) participants were women who had experienced maternity care in the UK. Study quality was appraised using the Critical Appraisal Skills Programme (CASP) qualitative research appraisal tool.

FINDINGS

Of 25,688 articles identified by the search strategy, 20 studies were identified that met the inclusion criteria. Five major themes were recognised: control, barriers to diet and exercise, motivators, relationship with weight, and information, with a further 12 subthemes. The majority of studies reported on weight gain (n = 10).

KEY CONCLUSIONS

Evidence shows that UK antenatal dietary advice is currently inconsistent, vague and overwhelming despite pregnancy being an excellent time for lifestyle change. Women are primarily driven by the health of their baby and desire support to facilitate positive changes.

IMPLICATIONS FOR PRACTICE

Findings outline a wishlist which highlights a desire for tailored information on preventing weight gain, dietary requirements, safe physical activity and a deprioritisation of food safety guidelines. This provision should be delivered by HCP. e.g. midwives, in a sensitive and supportive way to bridge the gap between women's needs and the current antenatal provision.

Experiences of lifestyle change among women with gestational diabetes mellitus (GDM): A behavioural diagnosis using the COM-B model in a low-income setting

Background

Lifestyle change can reduce the risk of developing type 2 diabetes among women with prior gestational diabetes mellitus (GDM). While understanding women’s lived experiences and views around GDM is critical to the development of behaviour change interventions to reduce this risk, few studies have addressed this issue in low- and middle- income countries. The aim of the study was to explore women’s lived experiences of GDM and the feasibility of sustained lifestyle modification after GDM in a low-income setting.

Methods

This was a descriptive qualitative study on the lived experiences of women with prior GDM, who received antenatal care at a public sector tertiary hospital in Cape Town, South Africa. Nine focus groups and five in-depth interviews were conducted with a total of thirty-five women. Data were analysed using content analysis and the COM-B (Capabilities, Opportunities, Motivations and Behaviour) model to identify factors influencing lifestyle change during and beyond the GDM pregnancy.

Results

The results suggest that the COM-B model’s concepts of capability (knowledge and skills for behaviour change), opportunity (resources for dietary change and physical activity) and motivation (perception of future diabetes risk) are relevant to lifestyle change among GDM women in South Africa. The results will contribute to the design of a postpartum health system intervention for women with recent GDM.

Conclusion

Our findings highlight the need for health services to improve counselling and education for women with GDM in South Africa. Support from family and health professionals is essential for women to achieve lifestyle change. The experience of GDM imposed a significant psychological burden on women, which affected motivation for lifestyle change. To achieve long-term lifestyle change, behaviour interventions for women with prior GDM need to address their capability, opportunity and motivation for lifestyle change during and beyond pregnancy.

The duration of the interpregnancy interval in multiparous women and maternal weight gain between pregnancies: findings from a UK population-based cohort

Maternal obesity in pregnancy increases the risk of adverse long-term health outcomes in both mother and offspring. A population-based cohort of prospectively collected routine antenatal healthcare data collected between January 2003 and September 2017 at University Hospital Southampton, UK was utilised to investigate the association between duration of interpregnancy interval between successive pregnancies and gain in maternal body mass index by the start of the next pregnancy. Records of 19362 women with two or more consecutive singleton live births were analysed. Two-thirds had gained weight when presenting to antenatal care for their subsequent pregnancy with 20% becoming overweight/obese. Compared to an interval of 24–35 months, an interval of 12–23 months was associated with lowest risk of weight gain (adjusted RR 0.91, 99% CI 0.87 to 0.95, p < 0.001) and ≥36 months with greatest risk (adjusted RR 1.11, 99% CI 1.07 to 1.15, p < 0.001) for the first to second pregnancy. This study shows that most multiparous women start their pregnancy with a higher weight than their previous one. An interval of 12–23 months is associated with the lowest risk of starting the second pregnancy with a higher body weight accounting for age. In countries with high prevalence of maternal obesity, birth spacing may merit exploration as a factor impacting on perinatal morbidity.

Women's experience with peer counselling and social support during a lifestyle intervention among women with a previous gestational diabetes pregnancy

Purpose

Women who are diagnosed with gestational diabetes mellitus have an increased risk of developing type 2 diabetes, but most receive little guidance regarding disease prevention. This study examined the role and usefulness of social support, including peer counselling in facilitating behaviour change as a part of a healthy eating and physical activity intervention among women with a previous gestational diabetes mellitus pregnancy.

Methods

We used a qualitative descriptive approach to investigate participants' experiences with the social support they received during the intervention. We used purposeful sampling and invited women and peer counsellors to participate in semi-structured interviews. Data were analyzed using content analysis.

Results

We interviewed nine women and two peer counsellors. Participants received emotional, appraisal, and informational types of social support from the peer counsellor and exercise specialist that they reported as useful. Additionally, participants' received informal emotional and instrumental support from family, friends, and colleagues that they found useful in supporting behaviour change.

Conclusions

Different types of social support are important to encourage behaviour change. These findings provide insight into the types of social support women with previous gestational diabetes mellitus find useful, in addition to practical ways that social support can be incorporated into future interventions.

The development of an intervention for diabetes prevention among people with impaired glucose regulation: feasibility and acceptability of an intervention component

Background

As part of the design process of a low-cost minimal-contact diabetes prevention intervention, we issued a blood glucose meter to people with impaired glucose regulation (who are at high risk of type 2 diabetes). We conducted a feasibility study to assess the acceptability of this intervention component and whether and how recipients engaged with it.

Methods

A blood glucose meter was given to 19 people identified through primary care, who were asked to use the meter in an exploratory way during a 4-week trial period, to try to understand the effect of different foods on the body. They were advised that they could test as often or as little as they liked and were also asked to keep a food/exercise diary for at least 1 week. They were interviewed about their experiences afterwards.

Results

There was a high level of engagement with testing, with the total number of tests recorded ranging from 11 to 114 (median 74) among 18 participants. Fifteen participants tested almost every day during the 4-week period. The cognitive engagement was more limited. All participants commented on their own results, and most were able to relate high or low results to foods eaten and exercise taken, usually in response to prompting. However, there was limited thought or understanding beyond this in terms of longer-term patterns of diet and exercise, and testing was routine rather than experimental. Some participants were confused by conflicting or unexpected results. A few minor problems were reported by participants, such as soreness, inconvenience, and difficulty in getting blood, but never enough to discontinue testing. Several participants stated that the meter was a useful aid as a reminder that they were at high risk of diabetes and served as a prompt that needed to make and/or maintain behaviour changes.

Conclusions

The study suggests that blood glucose monitoring is acceptable to people with impaired glucose regulation and that they would engage with it as part of an intervention to improve their diet. The study has also uncovered potential mechanisms of action for behaviour change.