An interpretive review of women's experiences of gestational diabetes mellitus: Proposing a framework to enhance midwifery assessment

doi:10.1016/j.wombi.2012.12.003

Women and Birth

Volume 26, Issue 2, June 2013, Pages e69-e76

https://doi.org/10.1016/j.wombi.2012.12.003 Get rights and content

Abstract

Background

Gestational diabetes mellitus (GDM) affects almost 5% of pregnancies in Australia, and within 15 years, 25% of affected women will go on to develop Type 2 Diabetes Mellitus (T2DM). The adoption of preventive health behaviours may be influenced by women's experiences of GDM.

Question

This review sought to understand women's beliefs, values, perceptions and experiences following diagnosis of GDM.

Methods

Peer reviewed and professional journals were searched for primary research, published between January 1991 and December 2011 that explored the beliefs, values, perceptions and experiences of peripartum or postpartum women with a diagnosis or history of GDM.

Findings

Nineteen studies met the inclusion criteria and the majority of these studies were qualitative (n = 15). Each study was reviewed and synthesis revealed three emergent themes and core concepts related to each theme: Responses (initial reaction to GDM diagnosis, negative thoughts following diagnosis, struggle to manage GDM, feelings of ‘loss of control’, changes to identity and adapting to change), Focus of Concern (concern for baby's health, mother's concern for her own health, perceived seriousness of GDM, perceived fear of T2DM) and Influencing Factors (cultural roles and beliefs, social stigmas, social support, professional support, adequate and appropriate information, social roles and barriers to self-care).

Conclusion

The experiences of women with GDM are unique and personal however this review highlights common experiences evident in the existing research. The proposed framework may be used by midwives in clinical assessment and care of women diagnosed with GDM.

Introduction

In Australia during 2005–07 gestational diabetes mellitus (GDM) affected approximately 4.7% of pregnancies.¹ Within 10 years, 17% of Australian women diagnosed with GDM will develop Type 2 Diabetes Mellitus (T2DM), and within 15 years prevalence rises to 25%.² To provide quality midwifery care to pregnant women with GDM, midwives need to understand the factors that influence women's behaviours.³ Consequently, an understanding of the beliefs, values and perceptions of women with GDM, or a history of GDM, is essential for quality individualised care during the antenatal, intrapartum and postpartum periods. This interpretive review seeks to understand women's beliefs, values and perceptions and how they influence the GDM experience following diagnosis.

Section snippets

Methods

An electronic database search was conducted using CINAHL, PubMed, Medline, Maternity and Infant Care and Informit. Keywords and truncations in various combinations included: gestational diabetes mellitus; experience; emotion; attitude; belief; feel; perceive; expect; mental health; psychosocial; wellbeing; lived experience; psychological; encounter; impact; and diagnosis. The inclusion criteria were:

Population: peri-partum or postpartum women;
Exposures: diagnosis or history of GDM;
Outcomes:

Results

Nineteen articles were included in the review as summarised in Table 1. The resulting studies (n = 15) spanned three main approaches to qualitative research; grounded theory, ethnography and phenomenology. The remaining studies undertook either a quantitative (n = 2) or a mixed methods approach (n = 2). The majority of the studies were conducted in Sweden (n = 7), followed by Australia (n = 5), United States of America and Canada (n = 3 respectively) while one case study⁴ did not identify its setting.

Discussion

This interpretive review aimed to explore women's experiences following GDM diagnosis. The studies in this review were predominantly qualitative and while the findings from individual studies are not generalisable to all women with GDM, there were common findings across the studies. Three main themes emerged from the literature in relation to women's experiences with GDM: Responses, Focus of Concern and Influencing Factors. Each theme contained a number of concepts. We propose that this

Conclusion

In order to enhance the quality of care provided to women with GDM, midwives need to understand the experiences of women diagnosed with GDM, or who have a history of GDM. While the experiences of individual women with GDM are unique and personal, this review has identified a framework drawn from common themes in the literature, which midwives may use to assess individual women's responses to the diagnosis of GDM, and throughout her ongoing care. The findings emphasise the requirement for more

References (26)

K. Hjelm et al.
Beliefs about health and illness postpartum in women born in Sweden and the Middle East
Midwifery
(2009)
H.T. Neufeld
Food perceptions and concerns of aboriginal women coping with gestational diabetes in winnipeg
Manitoba Journal of Nutrition Education and Behavior
(2011)
B. Sjögren et al.
Gestational diabetes: a case–control study of women's experience of pregnancy, health and the child
Journal of Psychosomatic Research
(1994)
K. Hjelm et al.
Beliefs about health and illness in women managed for gestational diabetes in two organisations
Midwifery
(2008)
K. Hjelm et al.
Swedish and Middle-Eastern-born women's beliefs about gestational diabetes
Midwifery
(2005)
Australian Institute of Health and Welfare. Diabetes in pregnancy: its impact on Australian women and their babies....
A.J. Lee et al.
Gestational diabetes mellitus: clinical predictors and long-term risk of developing type 2 diabetes: a retrospective cohort study using survival analysis
Diabetes Care
(2007)
H. Razee et al.
Beliefs, barriers, social support, and environmental influences related to diabetes risk behaviours among women with a history of gestational diabetes
Health Promotion Journal of Australia [Internet]
(2010)
L.L. Exelbert
Case study: a comparison between a “terror” reaction and a “nonchalant” reaction to the diagnosis of gestational diabetes
Clinical Diabetes
(2008)
S. Daniells et al.
Gestational diabetes mellitus: is a diagnosis associated with an increase in maternal anxiety and stress in the short and intermediate term?
Diabetes Care
(2003)

M.K. Evans et al.

Gestational diabetes: the meaning of an at-risk pregnancy

Qualitative Health Research

(2005)

A. Lindmark et al.

Perception of healthy lifestyle information in women with gestational diabetes: a pilot study before and after delivery

European Diabetes Nursing

(2010)

M. Persson et al.

‘From stun to gradual balance’ – women's experiences of living with gestational diabetes mellitus

Scandinavian Journal of Caring Sciences

(2010)

Cited by (64)

Diabetes in pregnancy: Women's views of care in a multi-ethnic, low socioeconomic population with midwifery continuity-of-care
2024, Women and Birth
Diabetes in pregnancy is diagnosed in 6% of pregnancies annually in Aotearoa-New Zealand, disproportionately affecting multi-ethnic, low socio-economic women. Little is known about the care experience of this population within the model of midwifery continuity-of-care, including views of telehealth care.
Increase understanding of the experience of diabetes in pregnancy care, including telehealth, among multi-ethnic, low socio-economic women receiving midwifery continuity-of-care.
Qualitative interview study with primarily indigenous and migrant women who had diabetes in pregnancy and gave birth 6–18 months previously. Interviewers were matched with participants by ethnicity. Transcripts were analysed using Framework analysis.
Participants were 19 women (5 Māori, 5 Pacific Peoples, 5 Asian, 4 European). Data analysis revealed three key themes: 1) ‘shock, shame, and adjustment’ to the diagnosis 2) ‘learning to manage diabetes in pregnancy’ and 3) ‘preparation for birth and beyond’ to the postpartum period.
Receiving the diagnosis of diabetes in pregnancy was a shock. Managing diabetes during pregnancy was particularly challenging for indigenous and migrant women, who wished for better access to culturally appropriate dietary and lifestyle information. Women appreciated having options of telehealth and face-to-face consultations. Preparation for birth and postpartum diabetes follow-up were areas requiring significant improvement. Challenges were mitigated through care from a consistent diabetes specialist midwife and community-based midwifery continuity-of-care.
Midwives were the backbone of diabetes in pregnancy care for this multi-ethnic, low socio-economic population. Care could be improved with more culturally appropriate diet and lifestyle information, better birth preparation, and expanded postpartum diabetes support.
Evaluation of knowledge about gestational diabetes mellitus among postpartum women and its connection with women's sociodemographic and clinical characteristics: a quantitative cross-sectional study
2022, Midwifery
to define the knowledge level among postpartum women affected by gestational diabetes and identify its association with women's sociodemographic and clinical characteristics.
a cross-sectional comparative study was conducted. Data collection took place in a single university hospital in the German speaking part of Switzerland.
a total of 107 postpartum women diagnosed with gestational diabetes in the current pregnancy completed a gestational diabetes mellitus specific knowledge questionnaire (GDMKQ) in German or English in their postpartum period. Further, sociodemographic and clinical characteristics were collected.
Women were between 24 and 45 years old, 56.1% had an academic degree, 60.7% were migrant women coming mainly from other European countries, 17.8% had a previous history of gestational diabetes, and 31.8% had a family history of diabetes. As measured with the GDMKQ, women with a higher educational level obtained higher scores and therefore showed a better knowledge level about gestational diabetes compared to women with primary and secondary educational levels (M 13.3 vs M 11.1 and 12.5; χ² (2) = 13.003, p = .002). In addition, women with a previous history of gestational diabetes also reached higher scores compared to women with no history of gestational diabetes (M 13.6 vs M 12.5, Z = − 2.278, p = .023).
Even if the knowledge status among women attending this single Swiss hospital is presently very good, a lower educational level was associated with a lower knowledge level and identified as the main factor to hinder women's comprehension of gestational diabetes. More individually tailored consultations by health care professionals may serve to meet women's needs more adequately and support them better in the understanding of their condition.
The psychosocial challenges associated with gestational diabetes mellitus: A systematic review of qualitative studies
2022, Primary Care Diabetes
Gestational diabetes is a disease with complex management that requires multidisciplinary collaboration. To achieve treatment goals, in addition to using medications and paying attention to exercise and diet, it is also important to take into account the mental health and psychosocial aspects of diabetes management. This study aimed to highlight these challenges associated with gestational diabetes.
This qualitative systematic review involved a search of the following databases: CINAHL, EMBASE, MEDLINE, and PsycINFO. Title, abstract, and full-text screening was done using Covidence software, and quality assessment of the included papers was conducted using the Critical Appraisal Skills Programme Checklist. Enhancing transparency in reporting the synthesis of the qualitative research statement (ENTREQ) was used in the design of this paper. Data synthesis was done using meta-aggregation method.
Out of the 2440 articles searched, 24 were qualitatively analyzed. The CASP score of the included papers was optimal. The 514 findings extracted from the 24 studies were aggregated into five broad conceptual categories: psychological challenges, socio-cultural challenges, information–communication challenges, challenges associated with a lifestyle change, and challenges related to health care.
Recognizing the psychosocial challenges associated with gestational diabetes and developing support packages tailored to psychosocial needs can help improve the management of these patients.
‘No sugar’, ‘no junk food’, ‘do more exercise’ – moving beyond simple messages to improve the health of Aboriginal women with Hyperglycaemia in Pregnancy in the Northern Territory – A phenomenological study
2021, Women and Birth
Globally, rates of hyperglycaemia in pregnancy are highest among Indigenous women. The highest prevalence has been documented among Aboriginal women in the Northern Territory of Australia. Despite knowledge of this for over two decades, there has been very limited examination of the specific needs and experiences of Aboriginal women regarding this condition.
How do Aboriginal women with hyperglycaemia in pregnancy understand and experience this condition, and how can their care be improved?
A phenomenological methodology underpinned semi-structured in-depth interviews with 35 Aboriginal women and seven health professionals across the Northern Territory. Data were inductively analysed.
The findings revealed that in general, participants in this study could recite simple health messaging regarding diabetes (e.g. ‘no sugar’), but many lacked in-depth knowledge and this affected the management of their condition. Nevertheless, many identified pregnancy as a powerful motivator for change, signalling scope to improve health messaging. Women consistently expressed the need for diabetes education that was culturally appropriate, a clear desire for maternity care that was family-centred, based on respectful relationships with the same care provider, and respected Aboriginal ways of knowing and being.
Existing health messaging around hyperglycaemia in pregnancy has limited reach with Aboriginal women in the Northern Territory. Reducing the burden of hyperglycaemia in pregnancy among these women requires a sustained commitment to redesign of maternity and diabetes care to incorporate the cultural and social context of women’s lives.
Diagnosing and providing initial management for patients with Gestational Diabetes: What is the General Practitioner's experience?
2020, Diabetes Research and Clinical Practice
This study explores the General Practice (GP) experience of Gestational Diabetes Mellitus (GDM). Much has been written about patient perspectives, yet little is known about the GP perspective at initial diagnosis and management. GDM is increasingly managed in the secondary and tertiary sector, the confidence of GPs and their role in ongoing care has not been examined. Given GDM’s poor follow up rates, all aspects of the patient journey warrant close examination.
Through purposive and snowball sampling, we conducted semi-structured interviews with GPs in Brisbane, Australia between April and October 2018. Data collection, until saturation, and analysis were concurrent, and the Leximancer analysis tool assisted with content analysis and suggestion of themes.
Dominant themes include uncertainty/urgency and feeling under-utilised. GPs have a pragmatic approach in the face of uncertainty, and adopt one of several strategies to meet patient needs. A key issue that may impact on long term follow up and high quality GP-patient relationships is concern about the patient being ‘taken away’ by the hospital. Communication with the hospital is generally perceived as poor.
The experience of GPs in the initial diagnosis and management of GDM may assist in improving GDM follow up.
Gestational diabetes: Changed health beliefs in migrant women from five Asian countries living in Sweden: A prospective qualitative study
2022, Primary Health Care Research and Development

View all citing articles on Scopus

View full text

Review articleAn interpretive review of women's experiences of gestational diabetes mellitus: Proposing a framework to enhance midwifery assessment

Abstract

Background

Question

Methods

Findings

Conclusion

Introduction

Section snippets

Methods

Results

Discussion

Conclusion

Midwifery

Manitoba Journal of Nutrition Education and Behavior

Journal of Psychosomatic Research

Midwifery

Midwifery

Gestational diabetes mellitus: clinical predictors and long-term risk of developing type 2 diabetes: a retrospective cohort study using survival analysis

Diabetes Care

Beliefs, barriers, social support, and environmental influences related to diabetes risk behaviours among women with a history of gestational diabetes

Health Promotion Journal of Australia [Internet]

Case study: a comparison between a “terror” reaction and a “nonchalant” reaction to the diagnosis of gestational diabetes

Clinical Diabetes

Gestational diabetes mellitus: is a diagnosis associated with an increase in maternal anxiety and stress in the short and intermediate term?

Diabetes Care

Gestational diabetes: the meaning of an at-risk pregnancy

Qualitative Health Research

Perception of healthy lifestyle information in women with gestational diabetes: a pilot study before and after delivery

European Diabetes Nursing

‘From stun to gradual balance’ – women's experiences of living with gestational diabetes mellitus

Scandinavian Journal of Caring Sciences

Review article
An interpretive review of women's experiences of gestational diabetes mellitus: Proposing a framework to enhance midwifery assessment