Background
Methods
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included pregnant women with a current diagnosis or women with a history of GDM;
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provided qualitative data on the psychosocial experiences of a diagnosis of GDM on women across any stage of pregnancy and/or the postpartum period; and
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where participants have provided an account of their experience or perspective of living with GDM
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the primary aim was to identify barriers and/or facilitators to service as these focused on the management of GDM rather than the GDM diagnosis; or
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participants were women diagnosed with diabetes before pregnancy
Search methods for identification of studies
Selection process
Data extraction
Data synthesis and analysis
Quality assessment
Results
Study characteristics
Author/Date/country | Aim of study | Method of data collection/point of data collection | Conceptual basis underlying the study (e.g. thematic analysis, grounded theory) | Participants/Recruitment/N/Population description |
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Studies collecting data during pregnancy | ||||
Carolan/2013 [29] Australia | To understand the experiences of women self-managing GDM | Phone interview, face-to-face interview and focus group | Thematic analysis | Pregnant women with a diagnosis of GDM/purposive sample/ N = 15 Caucasian, Asian, South Asian, Indian and Arabic |
Carolan-Olah et al./2017 [12] Australia | To explore the experiences of a group of Hispanic women of Mexican origin who had been diagnosed with GDM | Semi-structured interviews | Thematic analysis | Pregnant Hispanic women with a diagnosis of GDM/convenience sample/ N = 18 Hispanic women of Mexican origin |
Doran/ 2008 [30] Australia | To explore lifestyle changes during pregnancy and post-partum with women who had experienced a pregnancy complicated by GDM | Interviews | Thematic analysis | Pregnant women with GDM and women who has accessed centres for GDM management within the past 18 months/purposive sample/ N = 38 Pacific Islanders |
Hjelm et al./2005 [41] Sweden | The aim of the present study was to compare beliefs about health and illness in women with GDM born in Swedish and in the Middle East | Semi-structured interviews | Thematic analysis | Pregnant women with GDM Interviews conducted at weeks 34–38/consecutive sample/ N = 27 (Sweden = 13) Swedish/Middle Eastern |
Persson et al./2010 [13] Sweden | To describe pregnant women’s experiences of acquiring and living with GDM during pregnancy | Semi-structured interviews | Grounded theory | Pregnant women with GDM/convenience sample N = 10 Swedish |
Kaptein et al./2015 [45] Canada | To gain insight into the reactions and experiences of women from multiple ethnic background diagnosed with GDM | Semi-structured telephone interviews | Thematic analysis | Pregnant women with a diagnosis of GDM/consecutive sample/ N = 19 Non-Caucasian (79%) |
Trutnovsky et al./2012 [59] Austria | To explore concerns, treatment motivation, mood state, QoL, and treatment satisfaction of women treated for GDM. | Semi-structured interviews and survey | Thematic analysis | Pregnant women with GDM/convenience sample/ N = 45 Caucasian |
Wah et al./2018 [60] Australia | To explore the understanding and self-management experiences of GDM among Chinese migrants | Semi-structured face-to-face interviews | Thematic analysis | Pregnant migrants of China ethnicity residing in Australia with a diagnosis of GDM/convenience sample/ N = 18 Chinese |
Salomon et Soares/2004 [55] Portugal | To understand how gestational diabetes patients experience the impact of this diagnosis during pregnancy and of significance they attribute to the disease | Semi-structured interviews | Content analysis | Pregnant women with a diagnosis of GDM/unclear N = 9 Not reported |
Hui et al./2014 [44] Canada | To explore the stress and anxiety experienced during dietary management for women with GDM | Food choice map semi structured interview Interviews conducted at 26–28 weeks gestation | Not specifically reported, described as thematic Themes | Pregnant women with diagnosis of GDM/purposive sample/ N = 30 Caucasian, Asian, African, and Aboriginal |
Hjelm et al. 2012 [42] Sweden | Explore beliefs about health and illness in women with gestational diabetes living in Sweden and born in Sweden or Africa | Semi-structured interviews Interviews conducted at weeks 34–38 | Categories with description extract | Pregnant women with a diagnosis of GDM/consecutive sample/ N = 23 (N = 13, Sweden) Swedish/African |
Hjelm et al. 2008 [43] Sweden | To explore beliefs about health, illness and health care in women with gestational diabetes mellitus (GDM) managed in two different organisations based on diabetology or obstetrics | Semi-structured interviews Interviews conducted at gestational weeks 34–38 | Thematic analysis | Women with a diagnosis of GDM/consecutive sample/ N = 23 Swedish/African |
Hirst et al. 2012 [37] Vietnam | To determine attitudes and health behaviours of pregnant women with GDM in Vietnam | Focus groups | Thematic analysis | Women with a diagnosis of GDM/purposive sample (Women sampled at gestational ages 28–38 weeks) N = 34 Vietnamese |
Han et al. 2015 [36] Australia | To explore women’s experiences after being diagnosed with borderline GDM | Semi-structured interviews | Content analysis Categories | Women with a diagnosis of borderline GDM Borderline GDM as a positive 50 g OGCT (1 h venous plasma glucose ≥7.8 mmol/L) followed by abnormal oral75g OGTT (fasting venous plasma glucose < 5.5 mmol/L and a 2 h glucose < 7.8 mmol/L) Eligible if they were participants in the IDEAL study/purposive sample/ N = 22 Caucasian and Asian |
Ge, Wikby et al. 2016 [35] Sweden | To explore beliefs about illness and health and self-care behaviour among urban Chinese women | Semi-structured interviews | Content analysis Categories | Pregnant women with diagnosis of GDM, 34-38th gestational weeks/purposive sample/ N = 17 Chinese |
Ge, Albin et al. 2016 [34] Sweden | To explore beliefs about health and illness and health-related behaviours among Chinese women with GDM in a Chinese sociocultural context. | Semi-structured interviews | Content analysis Categories | Pregnant women with a diagnosis of GDM, 34-38th gestational weeks/purposive sample/ N = 15 Chinese |
Bandyopadhyay et al. 2011 [28] Australia | To explore the experiences and understanding of South Asian women after a diagnosis of GDM | Face-to-face interviews | Not specifically reported, described as thematic analysis Themes | South Asian women diagnosed with GDM/convenience sample/ N = 17 South Asian |
Araujo et al./2013 [26] Brazil | To understand the significance of the experiences of women with gestational diabetes mellitus | Open interviews and participant drawings 4 women in 1st trimester, 3 in 2nd trimester & 3 in 3rd trimester | Not specifically reported, described as thematic analysis | Women with GDM diagnosis/convenience sample/ N = 12 South American |
Evan et Brien 2005 [12] Canada | To gain an in-depth understanding of GDM as experienced by pregnant women | Interviews Interviews conducted prior to delivery and 6–8 weeks postpartum | Thematic analysis | Women with GDM diagnosis/purposive sample/ N = 12 Caucasian |
Studies collecting data within the 1st 12 months post-natal | ||||
Bandyopadhyay et al./2015 [27] Australia | To capture in-depth exploration of the experiences and perspectives on postpartum glucose tolerance test screening of South Asian women diagnosed with GDM | Interviews Interviews were conducted antenatally after diagnosis, after birth, 9 weeks to 52 weeks | Thematic analysis | South Asian women with diagnosis of GDM/convenience sample/ N = 40 South Asian |
Draffin et al./2016 [19] United Kingdom | To explore the concerns, needs and knowledge of women diagnosed with GDM | Focus groups | Thematic analysis | Pregnant women with a diagnosis of GDM or a history of GDM within past 12 months/convenience sample/ N = 19 White, Black African, Pakistani Latin American, Bangladeshi, Indian |
Doran et Davis 2010 [31] Tongan | To explore GDM in Tonga, with women who experienced GDM and health professionals who worked in the GDM/diabetes area | Semi-structured face to face interviews | Not specifically reported, described as thematic analysis Themes | Women who had experienced GDM in the previous 12 months /unclear/ N = 11 Pacific Islanders |
Figueroa Gray et al./2017 [33] USA | To foreground women’s experience with insulin and oral hypoglycemic agents. | Focus group | Thematic analysis | Women with GDM history and completed at least one prescription for insulin or oral hypoglycaemic medication during pregnancy within past 3 years/purposive sample/ N = 16 Caucasian, African American, Asian, Hispanic or Latina |
Hjelm et al. 2009 [40] Sweden | To explore beliefs about health and illness 3 month postpartum in women born in Sweden and the Middle East, and to study whether they perceive gestational diabetes mellitus as a prediabetic condition | Interviews | Headings and descriptions Divided into Middle-Eastern born and Swedish born women | Women 3 months postpartum who had previously had GDM /consecutive sample/ N = 27 Swedish and Middle Eastern |
Hjelm et al./2012 [42] Sweden | To explore the development over time of belief about health, illness and health care in migrant women with gestational diabetes born in the Middle East and living in Sweden | Semi-structured interviews Interviews conducted at weeks 34–38, three and 14 months after delivery | Content analysis | Middle Eastern women with a diagnosis of GDM/consecutive sample/ N = 14 Swedish and Middle Eastern |
Hjelm et al. 2018 [39] Sweden | To explore the development over time, during and after pregnancy, of beliefs about health, illness and healthcare in migrant women with GDM born in Africa living in Sweden | Semi-structured Interviews conducted in gestational weeks 34–38 and 3 and 14 months after delivery | Framework analysis using the Health Belief Model | Women with a diagnosis of GDM/convenience sample/ N = 9 African |
Kilgour et al./2015 [46] Australia | To explore and assess women’s communication experiences of postnatal GDM follow-up | Interviews Interviews at 12–16 weeks after birth | Thematic analysis | Women with GDM diagnosis/“theoretical sample”/ N = 13 Caucasian, Asian and Indian |
Lawson et Rajaram/1994 [47] USA | To explore the meaning women attach to GDM | Semi-structured interviews Interviews once prenatally and again at 6 weeks | Thematic analysis | Women with diagnosis of GDM/purposive sample/ N = 17 Caucasian, Black and Asian-American |
Neufeld/2011 [49] Canada | To describe how aboriginal women in an urban setting perceive dietary treatment recommendations associated with GDM | Interviews | Thematic analysis | Aboriginal women with GDM or a previous diagnosis of GDM within past 5 years/convenience sample/ N = 29 Aboriginal |
Svensson et al./2018 [56] Denmark | To examine how Danish women with a history of GDM experience the transition from a GDM-affected pregnancy to the postpartum period | Interviews Interviews within 3–5 months after delivery | Content analysis Themes | Women diagnosed with GDM/convenience sample/ N = 6 Caucasian |
Tang et al./2015 [57] USA | To gain insight of Hispanic and African-American women’s views on prevention of T2DM after GDM. | Semi-structured interviews | Thematic analysis | Women with a history of GDM (within 12 months of delivery at the time of initial contact)/purposive sample/ N = 23 African-American |
Whitty-Rogers et al./2016 [61] Canada | To explore Mi’kmaq women’s experiences with GDM. | Conversational interviews | Hermeneutic phenomenology Themes | Mi’kmaq women with history of GDM/purposive and snowballing sample/ N = 9 Aboriginal |
Studies collecting data at follow up screening for Type II diabetes | ||||
Abraham et Wilk/2014 [25] USA | To explore the lived experiences of women in rural communities with GDM and potentially gain insight into the low reported return rates for PPG testing | Semi-structured interviews | Phenomenological approach Themes | Women with a history of GDM in the last 2 to 5 years/purposive and snowballing sample/ N = 10 Caucasian |
Eades et al./2018 [32] UK | To explore experiences, knowledge and perceptions of women with GDM to inform the design of interventions to prevent or delay Type 2 diabetes | Semi-structured interviews | Theoretical framework – Self-Regulation Themes | Women with history of GDM diagnosis, within 1-year post delivery/convenience sample/ N = 16 Caucasian, Asian, Black and African |
Nielsen et al./2015 [50] Denmark | To improve our understanding of how women with gestational diabetes experience the treatment and care offered by a regional health service. To understand how the women’s experiences influenced their subsequent participation in follow-up screening. | Semi-structured interviews | Thematic analysis | Women with a previous diagnosis of GDM within 1–2 years after birth/convenience sample/ N = 7 Caucasian and Asian |
Parsons et al./2018 [51] UK | To describe the experiences of women from a demographically diverse population of their GDM and GDM care, to help inform healthcare delivery for women both during and after pregnancy | Interviews and focus groups | Framework analysisThemes | Women with a previous diagnosis of GDM (within past 5 years)/purposive sample/ N = 50 Black, Caucasian, and Asian |
Razee et al./2010 [54] Australia | To explore the beliefs, attitudes, social support, environmental influences and other factors related to diabetes risk behaviours among Arabic, Cantonese/Mandarin, and English speaking women with recent GDM | Semi-structured interviews | Not specifically reported, described as thematic analysis | Women who had completed a GDM pregnancy in the previous 6–36 months/purposive sample/ N = 57 Middle Eastern, Chinese and White Australian |
Rafii et al./2017 [53] Iran | To understand Iranian women’s experiences in diabetes screening after childbirth | Semi-structured interviews Interviews at 6–21 months postpartum | Grounded theory methodology Themes and sub-themes | Women with previous GDM diagnosis /purposive sample/ N = 22 Asian |
Tierney et al./2015 [58] Ireland | To assess the lifestyle behaviours undertaken by a group of women both during and after their GDM pregnancy | Semi-structured interview | Thematic analysis | Women with a history of GDM in the previous 3.6–6.6 years/convenience sample/ N = 13 Not reported |
Pennington et al./2017 [52] Australia | To explore the views of GPs and women who have had GDM | Semi-structured interviews | Content analysis | Women with a history of GDM/purposive sample/ Timeframe not reported N = 16 Not reported |
Lie et al./2013 [48] United Kingdom | To explore factors influencing post-natal health behaviours following the experience of gestational diabetes | Semi-structured interviews | Framework analysis | Women with a history of GDM within the last 2 years/purposive sample/ N = 37 Caucasian and non- Caucasian |
Quality appraisal
Thematic analyses
No | Theme | Supporting data |
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1 | Initial psychological impact | ‘I was very surprised and very upset to be diagnosed. I felt a little bit of a failure.’ [31] ‘You actually feel guilty, right? Because this baby hasn’t asked for this; and what if the baby comes out and has some kind of disease? Then it’s my fault.’ [58] ‘GDM was a hidden blessing for me... GDM can go away after you have the baby but diabetes is not so easily fixable …I am much more aware of [the] need to prevent it.’ [32] ‘It’s also good with my diabetes diet I ended up weighing pretty much the same at the end of the pregnancy as I did at the beginning.’ [31] |
2 | Communicating the diagnosis | ‘Like they don’t have time to sit there and talk to you about what to do about it [GDM], but they are always in a hurry [………] so I just don’t bring it up and they don’t bring it up; so you just get checked out and leave.’ [26] ‘They sent me off to the dietician and I came out depressed....I went “nuh - if I eat what you’re telling me”... and she was telling me I had to eat carbs with every meal. I knew it wouldn’t control my BSL [blood sugar level]...hadn’t they read the latest research about a high protein diet being more beneficial that a high carb diet? [32]. ‘scared that if the sugar was too high they would take the baby out [33]. ‘Nobody told me anything about type 2 diabetes...they were so focused on the immediate pregnancy problems; within a medical model...OK, if we don’t get it under control, we will just put you on insulin... just a drug solution.’ [32] ‘They [hospital dieticians] don’t have much information on for example some Chinese dishes, so I would go on the Internet and check if they’d raise my blood sugar. .. but even on the Internet, it’s hard to find information like that.’ [62] |
3 | Knowledge of GDM | ‘I thought it was the end of the world because I didn’t fully understand it’ [27]. ‘At first I thought: it must be because I ate a lot sweet, overweight ... but then I was talking to the girl, she said it must be family, right??’ [57] ‘My husband, he always knew me like this ... is ... healthy, without any illness. [...] Because he is kind of ignorant in these matters, you know. He thinks that diabetes ... that I’m dying! ... And my boy too, is half pensive, cautious, thinking I’m going to die.’ [57] ‘I did not know that rice can have that much sugar. That’s one thing really, really surprised me. I’m thinking that sugar normally comes from cakes and chocolate.’ [31] I’ve eaten something and I’ve thought my reading’s not going to be good after this and it’s been fine. So it was mainly getting my head around it’s not just the sugars. Like Special K for example. That was on my list of things that I could have and then the lady (educator) said, ‘What did you have for breakfast? And I said I had Special K. She said, ‘it obviously doesn’t work for you. So you either have to up your insulin, if you want to just keep eating Special K, or just stop eating it.’ [31] ‘You’d think, okay, well this will be good; this will be fine for me to eat. Then I will check my sugars 2 h later and it would not. I would be why? That’s not okay. It was disappointing, and it was definitely stressful, like it was just really not fun.’ [46] If the mother breastfeeds her baby the ‘diabetes factor’ may transmit to the baby and it’s no good. It may make the baby have the same disease afterwards’ [39] ‘I’m concerned about that (transmission of diabetes to the infant) of course’ [39] |
4 | Risk perception | ‘coming back as borderline gestational diabetes wasn’t such an issue as having full-blown diabetes...and I don’t worry about it.’ [38] ‘I’m afraid this diet won’t provide enough nutrients for the baby, but the doctor told me to do that’ [38] ‘since, after giving birth and everything’s back to normal so I’ve sort of been making up for lost time a little bit with all the chocolate I couldn’t have.’ [52] ‘It’s actually quite odd that during birth, they monitored everything closely, and as soon as I had delivered they served me a piece of white bread.’ [52] |
5 | Managing GDM | ‘It is frustrating still when you watch your carbs, you portion it and your reading is still high, almost every day.’ [46] ‘I’ve been doing everything right. My sugar is so unstable. The highest reading was 202 with my insulin. I have eaten the right foods, exercised, and tested my glucose levels four times a day. I had some high ones of 151. When my insulin dosages are increased, I am more depressed. I feel worthless.’ [49] ‘I really wanted to control it through my diet and exercise. I was strongly motivated to do all I could so I didn’t have to introduce another needle.... But when I went on insulin I relaxed.’ [32] ‘..my baby might die if I’m not on [a] diet.’ [39] ‘Well, you are deviant from others. It’s like a functional handicap in that aspect’ [15]. ‘I’m a full-time working mom, so I had to carry a little refrigerator with me with the insulin to work every day and on weekends to the restaurant and have to hide in the bathroom. It made me feel like I’m totally an illegal person.’ [35] |
6 | Burden of GDM | ‘The whole pressure with the whole everything, it really did affect me and I think it’s probably one of the worst times I’ve had in my life actually.’ [53] ‘I would have crashes where I’d be driving on the freeway, and I’m at a crazy low number, and I have to try to find some candy or something in my car. So it was very frustrating.’ [35] ‘because it is really ugly to have, in fact I wanted to have another baby and since I got this I do not want to anymore.’ [14] |
7 | Social support | ‘Well, I wouldn’t have done it without my partner like because he was like, “Up, eat now, insulin,” you know, and I would be, “Yeah, I’m going to get up in 20 min and I’m going to do this,” and he was like, “Now, eat, your insulin,” you know.’ [21] ‘he’s now cooking more for me and he’s healthier because he doesn’t, because if he’s going to eat junk food that’s just going to make me jealous. So he’s kind of trying to eat healthy as well for me.’ [31] ‘My mother-in-law phoned relatives and told the villagers that my baby was not healthy because I had GDM...’ [37] |
8 | Gaining control | ‘You have an active role and you can take charge of what’s going on rather than just roll along.’ [12] ‘I believe in not giving in to diabetes. I will take care of myself and control the diabetes.’ [49] ‘I looked at herbal remedies because that’s something that [laughing], you know, you think is quite safe [21] |