Diagnostic Controversy: Gestational Diabetes and the Meaning of Risk for Pima Indian Women

Abstract

Gestational diabetes is the one form of this well known, chronic disease of development that disappears. After the birth of the child, the mother's glucose levels typically return to normal. As a harbinger of things to come, gestational diabetes conveys greater risk for later type 2 (previously "non-insulin dependent") diabetes in both the mother and child. Thus, pregnant women have become a central target for prevention of this disease in the entire Pima population. Based on ethnographic interviews conducted between 1999 and 2000, I discuss the negotiated meanings of risk, "borderline" diabetes, and women's personal knowledge and experiences of diabetes, particularly during the highly surveilled period of pregnancy. I also highlight the heterogeneity of professional discourse pertaining to gestational diabetes, most notably the debate surrounding its diagnosis. Significantly, women's narratives reveal the same set of questions as is raised in the professional debate. Implications for diabetes prevention and for balancing the increased surveillance of pregnant women with clinical strategies that privilege their experience and perspectives are also discussed.

Applying Syndemics and Chronicity: Interpretations from Studies of Poverty, Depression, and Diabetes

“…Rather, diabetes and depression interact in complex ways with each other and with the social conditions in which they occur, and these relationships change over time. As many other scholars have noted (e.g., Kleinman 1988;Lock 2001;Luhrmann 2001;Smith-Morris 2005), biomedical nosologies that make sharp distinctions between diseases do not necessarily reflect the realities of human illness as they are lived from day to day.…”

“…Efforts to manage illness flare-ups over time can become a guiding principle as individuals struggle to regain a sense of normalcy, and may alter people's participation in key social roles such as parent, career woman, and friend (Becker 1994(Becker , 1997Bury 1982;Charmaz 1991;Greenhalgh 2001;Maynard 2006;Murphy 1987). This is particularly true for diabetes; ethnographic research in various global settings shows that intensive identity work is involved in overcoming the disruptions created by diabetes' lifestyle requirements, self-monitoring, fluctuating test results, and sometimes unclear diagnostic categories (Manderson and Kokanovic 2009;Naemiratch and Manderson 2008;Smith-Morris 2005. Chronicity emphasizes how the accumulation of physical symptoms over time has concomitant accruing psychological, identity-related, and social ramifications.…”

Changing Diagnostic and Treatment Criteria for Chronic Illness: A Critical Consideration of Their Impact on Low-Income Hispanic Patients

“…Notably, they have described Hispanic patients’ interpretations and causal understandings of diabetes (Baer, et al 2012; Mendenhall, et al 2010; Smith-Morris 2005), and have identified differences between clinician and patient health beliefs which may lead to different management expectations or clinical miscommunication (Chavez 2004; Hunt, et al 1998a; Maupin and Ross 2012; Weller, et al 2012). Others have examined structural barriers to care which may negatively impact the health of Hispanics, such as inadequate translation services, lack of insurance, undocumented immigrant status and poverty (Becker 2004; Castaneda 2010; Castaneda, et al 2010; Durden and Hummer 2006; Handley and Joseph 2008; Hunt and Voogd 2007).…”

“…Minority populations have been found to be especially at risk for these conditions (ADA 2011; Carroll, et al 2012; CDC 2011; Fryar, et al 2010). Anthropologists and other social scientists have extensively explored the vexing question of the causes and remedies for these disparities, and a good deal of effort is going toward identifying the barriers and facilitators of screening and management for these populations (Aroian, et al 2012; Ferzacca 2012; Hunt, et al 1998b; Maupin and Ross 2012; Smith-Morris 2005; Weller, et al 2012). While such efforts have made important contributions to improving access to quality health care, recent changes in clinical diagnostic and treatment guidelines raise new sets of issues for social scientists concerned with chronic illness among marginalized populations.…”

Risky Bodies: Allocation of Risk and Responsibility within Fetal Alcohol Spectrum Disorder (FASD) Prevention Campaigns

“…These messages also fail to consider that for certain groups, the ability to engage in self care is tied to larger struggles concerning economic insecurity, land rights, colonialism, autonomy and citizenship (Fee, 2006;Raphael, 2014;Smith-Morris, 2005). The limitations of risk and responsibility discourses are further illustrated in this paper through the deconstruction of FASD prevention campaign utilized in the province of Alberta, Canada.…”