Australian women's experiences of living with gestational diabetes

Abstract

Purpose

The purpose of this study was to describe Australian women's reflections on the experience of having a pregnancy affected by GDM.

Methods

Participants were women aged ≥18 years, diagnosed with GDM ≤3 years previously and registered with the National Diabetes Services Scheme. Data was collected from a cross-sectional written postal survey which included the opportunity for women to document their experiences of living with GDM. Thematic framework analysis was undertaken to determine underlying themes.

Results

Of 4098 invited eligible women, 1372 consented to participate. Of these, 393 provided feedback on their experiences of living with GDM. Eight key themes emerged from the data (1) shock, fear and anxiety (8.9%), (2) uncertainty and scepticism (9.4%), (3) an opportunity to improve one's health (9.6%), (4) adapting to life with GDM (11.6%), (5) the need for support (17.2%), (6) better awareness (3.5%), (7) abandoned (14.9%), (8) staying healthy and preventing diabetes (13.7%). Women taking insulin were more likely to experience shock, fear or anxiety (p = 0.001) and there was a trend towards women who spoke another language also being more likely to report this experience (p = 0.061). Those diagnosed with GDM in a previous pregnancy (p = 0.034) and younger women (p = 0.054) were less likely to view the diagnosis as an opportunity to improve their health.

Conclusions

This study provides an insight into the experience of the pregnant woman diagnosed with GDM. It emphasises the importance of health professional support and provides insight into the challenges and opportunities for future diabetes risk reduction.

Introduction

Gestational diabetes mellitus (GDM) is a form of diabetes with onset or first recognition during pregnancy.¹ GDM affects approximately 5% of pregnancies in Australia, increasing up to 14% in some high risk groups.² With evidence suggesting that rates of GDM are currently increasing in Australia,² it is important for health professionals to understand the impact of the diagnosis and the experiences of women living with GDM. This can help identify priorities for health care provision and inform interventions to meet the needs of women with GDM.

GDM has been demonstrated to pose perinatal risks³ as well as adverse maternal health consequences including an increased risk of future type 2 diabetes.4, 5 Treatment of GDM may lower the risk of birth complications,⁶ however this requires intensive ante-natal interventions and day to day self-management to achieve optimal glycemic control.¹

Some evidence suggests that a diagnosis of GDM may increase a woman's anxiety,⁷ result in poorer health perceptions and a less positive pregnancy experience when compared with non-diabetic controls.⁸ A Canadian study described the experiences of women diagnosed with GDM as living a controlled pregnancy, followed by a process of adaptation to the diagnosis, while burdened by the moral obligation to be a responsible mother and being worried about potential impact on future health.⁹ Similarly, Nolan et al. (2011) in research with US women with GDM and type 2 diabetes identified three primary themes related to concern for the infant, concern for self and sensing a loss of personal control over their health.¹⁰ Research with Swedish women described the diagnosis as a process of ‘stun to gradual balance’, where both positive and negative elements were reported.¹¹

Several Australian studies to date have provided some insight into the experiences of women with GDM. Carolan (2013) using focus groups and semi-structured interviews with 15 women with GDM, examined women's experiences with diabetes self-management.¹² In the process of adjusting to GDM, they described four discrete themes, relating to the shock of diagnosis, coming to terms with GDM, working it out/learning new strategies and looking to the future. Each adjustment phase was underpinned by the fifth theme of having a supportive environment. Adherence to the GDM management plan was reported to be motivated by thinking about the baby. In a study examining factors that facilitate or inhibit GDM self management in Australian women, time pressures, physical and social constraints, comprehension difficulties, and insulin as an easier option were described as barriers to self management. Thinking about the baby and psychological support from partners and families were facilitators.¹³ In telephone interviews with 57 women with previous GDM, Razee et al. (2010) highlighted a number of social and cultural barriers influencing their ability to follow a healthy lifestyle in the post-natal period.¹⁴ Doran (2008) examining perspectives on lifestyle changes in interviews with eight Australian women also reported a lack of support for post-natal risk reduction.¹⁵ While these studies provide an insight into women's experiences, the samples were drawn from health service based data sets which may limit the generalisability of the results.

The aim of our study was to build on these findings by describing Australian women's reflections on the experience of having a pregnancy affected by GDM in a large sample of women from a national gestational diabetes register. A secondary aim was to describe associations between the characteristics of respondents and their GDM pregnancy experience.