Experiences of gestational diabetes and gestational diabetes care: a focus group and interview study

Abstract

BackgroundGestational diabetes mellitus (GDM) is an increasingly common condition of pregnancy. It is associated with adverse fetal, infant and maternal outcomes, as well as an increased risk of GDM in future pregnancies and type 2 diabetes for both mother and offspring. Previous studies have shown that GDM can result in an emotionally distressing pregnancy, but there is little research on the patient experience of GDM care, especially of a demographically diverse UK population. The aim of this research was to explore the experiences of GDM and GDM care for a group of women attending a large diabetes pregnancy unit in southeast London, UK, in order to improve care.MethodsFramework analysis was used to support an integrated analysis of data from six focus groups with 35 women and semi-structured interviews with 15 women, held in 2015. Participants were purposively sampled and were representative of the population being studied in terms of ethnicity, age, deprivation score and body mass index (BMI).ResultsWe identified seven themes: the disrupted pregnancy, projected anxiety, reproductive asceticism, women as baby machines, perceived stigma, lack of shared understanding and postpartum abandonment. These themes highlight the often distressing experience of GDM. While most women were grateful for the intensive support they received during pregnancy, the costs to their personal autonomy were high. Women described feeling valued solely as a means to produce a healthy infant, and felt chastised if they failed to adhere to the behaviours required to achieve this. This sometimes had an enduring impact to the potential detriment of women’s long-term psychological and physical health.ConclusionsThis study reveals the experiences of a demographically diverse group of patients with GDM, reflecting findings from previous studies globally and extending analysis to the context of improving care. Healthcare delivery may need to be reoriented to improve the pregnancy experience and help ensure women are engaged and attentive to their own health, particularly after birth, without compromising clinical pregnancy outcomes. Areas for consideration in GDM healthcare include: improved management of emotional responses to GDM; a more motivational approach; rethinking the medicalisation of care; and improved postpartum care.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1657-9) contains supplementary material, which is available to authorized users.

A qualitative study exploring women's health behaviours after a pregnancy with gestational diabetes to inform the development of a diabetes prevention strategy

“…The study followed a qualitative design using in-depth interviews and focus groups, as previously described [14]. Participants were recruited through a large teaching hospital in London, UK, which supports a diverse set of people.…”

“…As described elsewhere [14], the interviews and focus groups were digitally recorded, transcribed verbatim and imported into NVivo version 10 for analysis using the framework approach, which defines a structured and systematic process for categorizing and organizing [17]. Two researchers (JP and KS) independently coded all the transcripts and a third researcher (AF) coded a subsection of transcripts.…”

Implementation of a new program of gestational diabetes screening and management in Morocco: A qualitative exploration of health workers’ perceptions

“…Empathy of providers has shown to increase satisfaction levels and compliance [28]. GDM diagnosis is often accompanied by patients' fears [29], and therefore requires a high degree of empathy to reduce anxiety. Studies have shown that nurses have a high capacity to provide empathic care [30,31].…”

Implementation of a new program of gestational diabetes screening and management in Morocco: A qualitative exploration of health workers’ perceptions

“…Empathy of providers has shown to increase satisfaction levels and compliance [29]. GDM diagnosis is often accompanied by patients' fears [30], and therefore requires a high degree of empathy to reduce anxiety. Studies have shown that nurses have a high capacity to provide empathic care [31,32].…”