Women's and healthcare providers’ perceptions of long‐term complications associated with hypertension and diabetes in pregnancy: a qualitative study

Abstract

Objectives A diagnosis of hypertensive disorders during pregnancy (HDPs) or gestational diabetes mellitus (GDM) is highly predictive of women at increased risk of developing chronic hypertension, Type 2 diabetes, and cardiovascular disease. This study investigates perceptions of women and healthcare providers in rural India regarding these long‐term risks. Design Qualitative study using modified grounded theory. Setting Two states in rural India: Haryana and Andhra Pradesh. Population Pregnant and postpartum women, community health workers (CHWs), primary care physicians, obstetricians, laboratory technicians, and healthcare officials. Methods In‐depth interviews and focus group discussions explored: (1) priorities for high‐risk pregnant women; (2) detection and management of HDPs and GDM; (3) postpartum management, and (4) knowledge of long‐term sequelae of high‐risk conditions. A thematic analysis was undertaken. Results Seven focus group discussions and 11 in‐depth interviews (n = 71 participants) were performed. The key priority area for high‐risk pregnant women was anaemia. Blood pressure measurement was routinely embedded in antenatal care; however, postpartum follow up and knowledge of the long‐term complications were limited. GDM was not considered a common problem, although significant variations and challenges to GDM screening were identified. Knowledge of the long‐term sequelae of GDM with regard to an increased risk of Type 2 diabetes and cardiovascular disease among doctors was minimal. Conclusions There is a need for improved education, standardisation of testing and postpartum follow up of HDPs and GDM in rural Indian settings. Funding SN is supported by an MRC Clinical Research Training Fellowship (MR/R017182/1). The George Institute for Global Health Global Women's Health programme provided financial support for the research assistant and fieldwork costs in India. Tweetable abstract Improved education and postpartum care of women with hypertension and diabetes in pregnancy in rural India are needed to prevent long‐term risks.

Barriers to postpartum diabetes screening: a qualitative synthesis of clinicians’ views

“…One study of clinicians’ views of long-term complications of GDM was published after completing the literature search. Nagraj et al ’s 32 study had a rural Indian setting with greater social and gender inequality. Competing priorities, vague roles, and resource limitations were similar to the findings of the present study; however, they also found that many physicians lacked awareness of the long-term implications of GDM, which was not prominent in the results of the present study.…”

Health Care Professionals’ Perspectives on Screening and Management of Gestational Diabetes Mellitus in Public Hospitals of South India – A Qualitative Study

“…Health care providers (HCPs) are subjected to stress due to heavy workload from over-crowding in public hospitals.. Screening for GDM during pregnancy was not found to be universal in two states of India, namely, Haryana and Andhra Pradesh (17). This study revealed deviation from protocol both by pregnant women as well as HCP.…”

Health care professionals’ perspectives on screening and management of gestational diabetes mellitus in public hospitals of South India – a qualitative study

“…In a study conducted in Kerala, India, clinicians did not even uniformly adhere to the National Health Mission’s recommendation of the management of GDM. This was found even with clinicians treating patients in a single hospital [ 17 , 18 ].…”

“…Health care providers (HCPs) are subjected to stress due to heavy workloads from over-crowding in public hospitals. Screening for GDM during pregnancy was not found to be universal in two states of India, namely, Haryana and Andhra Pradesh [ 17 ]. This study revealed deviation from protocol both by pregnant women as well as HCPs.…”