Australian women's experiences of living with gestational diabetes

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

Factors that positively influence in-hospital exclusive breastfeeding among women with gestational diabetes: An integrative review

ProblemWomen with gestational diabetes have higher rates of introducing infant formula before leaving hospital.BackgroundDespite health professional support, less women with gestational diabetes exclusively breastfeed in hospital.AimTo find factors that positively influence in-hospital exclusive breastfeeding practices among women with gestational diabetes.MethodsAn online search was performed in Medline, Scopus, Pubmed, CINAHL and Cochrane databases. Studies containing the keywords gestational diabetes and breastfeeding were retrieved.FindingsAuthors identified 1935 papers from search criteria. Twenty-six papers with no restrictions on research design met inclusion criteria and were included in the review. Factors were divided into personal, antenatal, intrapartum and postnatal factors. The main modifiable factors that were associated with improved in-hospital exclusive breastfeeding rates were having a strong intention to breastfeed, being confident, feeling supported and having continuity of education and support. Women’s main reasons to introduce formula were related to baby’s hypoglycaemia, delayed lactogenesis II and perceived low milk supply. Skin-to-skin contact after birth combined with frequent breastfeeds were effective ways to improve in-hospital exclusive breastfeeding rates.ConclusionInfluencing factors such as women’s breastfeeding intention, confidence and ongoing support are no different to the general population of women. However, promoting skin-to-skin contact after birth combined with frequent feeds are crucial for women with gestational diabetes who are more likely to introduce formula due to delayed lactogenesis II and fear of neonatal hypoglycaemia. There is a need for developing educational and supportive interventions that are tailored specifically for women who have gestational diabetes.     

Factors associated with early cessation of breastfeeding in women with gestational diabetes mellitus

AimTo determine factors associated with early cessation of breastfeeding (≤3 months) in women with recent gestational diabetes mellitus (GDM).MethodsA cross-sectional online survey of women aged ≥18 years, diagnosed with GDM in 2010 and registered with the National Diabetes Services Scheme in Australia. The 59 questions examined breastfeeding duration, intention, attitudes, exclusivity and support.Results738 women completed the survey (15% response rate). Data was analysed for 729 eligible respondents. Of these 97% reported ‘ever’ breastfeeding and 19% had breastfed for ≤3 months. Cessation of breastfeeding at or before 3 months was associated with breastfeeding problems at home [adjusted odds ratio 8.01, 95% confidence interval (4.57, 14.05)], return to work prior to three months [OR 3.39 (95% CI 1.53, 7.55)], inadequate breastfeeding support [OR 1.88 (95% CI 1.10, 3.22)], caesarean delivery [OR 1.70 (95% CI 1.04, 2.76)], low socioeconomic status (SEIFA 1 unit increase) [OR 0.89 (95% CI 0.81, 0.97)] and BMI (2 unit increase) [OR 1.08 (95% CI 1.01, 1.57)]. Being married or de facto [OR 0.14 (95% CI 0.03, 0.62)] was a protective against early cessation of breastfeeding.ConclusionStrategies to improve breastfeeding duration in women with GDM need to address those most at risk of early cessation and provide appropriate postpartum breastfeeding support in this group.     

Reasons for women's non-participation in follow-up screening after gestational diabetes

BackgroundDue to the increased risk of type 2 diabetes, follow-up screening after birth is recommended to women with previous gestational diabetes. Low participation in such screening has been shown to delay detection of diabetes with potentially serious consequences for the women's future health. The women's experiences of treatment and care during their pregnancies may affect participation.AimThis study aimed at understanding the women's experiences with treatment and care during pregnancy and to understand how these experiences influence participation in follow-up screening.MethodsA qualitative study was undertaken drawing on a phenomenological methodology. Seven women treated for gestational diabetes at a university hospital in the North Denmark Region participated in interviews.FindingsThe women experienced lack of continuity in care between hospital departments and health sectors. We identified the following causes for low participation in follow-up screening: poor coordination, little elaboration of information, a lack of clear coordination of responsibility for follow-up screening among health care professionals and absence of focus and inclusion of their individual needs and preferences.ConclusionThe women wished to be reminded of screening to increase their sense of safety. The women's experiences seem to reflect a lack of patient-centeredness during the pregnancy, which may be remedied by increasing the focus on the women's need for improved continuity in treatment and care. Participation in follow-up screening after gestational diabetes may be increased by sending reminders to the women. Raised awareness of the women's individual needs and preferences for treatment and care offers potential for improvement.     

Barriers and coping strategies of women with gestational diabetes to follow dietary advice

ObjectiveTo understand barriers and coping strategies of women with gestational diabetes (GDM) to follow dietary advice.DesignQualitative study.ParticipantsThirty women with GDM from the Winnipeg area participated. Each participant completed a Food Choice Map (FCM) semi-structured interview and a demographic questionnaire.Major outcome measuresUnderlying beliefs of women with GDM and factors that hinder following dietary advice.AnalysisQualitative data analyzed using constant comparative method to identify emergent themes of factors and beliefs that affected following dietary advice. Themes were categorized within the Integrative Model of Behavioral Prediction.ResultsGDM women faced challenges and barriers when (1) personal food preference conflicted with dietary advice; (2) eating in different social environments where food choice and portions were out of control and food choice decisions were affected by social norms; (3) lack of knowledge and skills in dietary management and lack of a tailored dietary plan.Conclusions and implicationsQuick adaptation to dietary management in a short time period created challenges for women with GDM. Stress and anxiety were reported when women talked about following dietary advice. Tailored educational and mental health consultation with consideration of the barriers may promote dietary compliance and overall better health.     

Barriers to a healthy lifestyle post gestational-diabetes: An Australian qualitative study

Background

Overseas-born-women from certain ethnicities are at high risk of type-2 diabetes and related metabolic disorders. This study explored the barriers and facilitators to long-term healthy lifestyle recommendations among Australian-born and overseas-born-women who attended health promotion sessions at a tertiary Australian Hospital for gestational diabetes 3–4 years previously.

Sleep quality and stress in women with pregnancy-induced hypertension and gestational diabetes mellitus

BackgroundPregnant women with complications including pregnancy-induced hypertension (PIH) and gestational diabetes mellitus (GDM) often experience disrupted sleep patterns because of activation of the sympathetic nervous system. These pathologies are aggravated by sympathetic nervous system activation and may be related to stress. The present study aimed to clarify the characteristics of and changes in sleep quality and stress in pregnant women with PIH and GDM during the second and third trimesters.MethodsWe enrolled 56 women in their second or third trimesters who were diagnosed with PIH or GDM. Participants completed questionnaires, including the Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS). Secretory immunoglobulin A (SlgA) concentrations were measured as a biological indicator of stress.ResultsPSS scores and subjective stress parameters were significantly higher than those reported from previous studies of healthy pregnant women (15.2 points and 15.1 points for the second and third trimesters, respectively).Mean one-day values for SIgA were 168.3 and 205.7 μg/mL for the second and third trimesters, respectively. During the second and third trimesters, SIgA scores were higher than those reported for healthy pregnant women in previous studies. The PSQI component scores sleep disturbance (C5) and sleep duration (C3) in follow up case were significantly higher in the third trimester than in the second trimester.DiscussionThis investigation suggests that pregnant women with PIH and GDM experience higher stress levels than do non-pregnant women and healthy pregnant women. Further, our results indicate that sleep quality worsens during the third trimester compared with the second trimester.     

The needs and experiences of women with gestational diabetes mellitus from minority ethnic backgrounds in high-income nations: A systematic integrative review

BackgroundGestational diabetes mellitus (GDM) represents a growing challenge worldwide, with significant risks to both the mother and baby that extend beyond the duration of the pregnancy and immediate post-partum period. Women from ethnic minority groups who access GDM care in high-income settings face particular challenges. The aim of this systematic integrative review is to explore the experiences and needs of women with GDM from select ethnic groups in high-income healthcare settings.MethodsFor the purposes of this systematic integrative review, a comprehensive search strategy explored the electronic databases CINAHL, Medline, Web of Science, and Scopus were searched for primary studies that explored the needs and experiences of women with gestational diabetes from select ethnic minority groups living in high-income nations. The ethnicity of the women in the study included: East, South and Southeast Asian, Indian subcontinent, Aboriginal/First Nations, Torres Strait Islander, Pacific Islander, Māori, Middle Eastern, African, or South/Latina American. Studies were assessed with the Crowe Critical Appraisal Tool and findings were synthesised with thematic analysis.ResultsThis review included 15 qualitative studies, one mixed method, and one cross-sectional study. Six high-income nations were represented. The voices and experiences of 843 women who originated from at least one ethnic minority group are represented. Four major themes were constructed: psychological impact of GDM, GDM care and education, GDM and sociocultural impact, and GDM and lifestyle changes.Discussion and conclusionLimitations exist in the provision of culturally appropriate care to support the management of GDM in women from select ethnic groups in high-income healthcare settings. Women require care that is culturally appropriate, considering the individual needs and cultural practices of the woman. Engaging a woman’s partner and family ensures good support is provided. Culturally appropriate care needs to be co-designed with communities so that women are at the centre of their care, avoiding a one-size-fits-all approach.     

Combination of a structured aerobic and resistance exercise improves glycaemic control in pregnant women diagnosed with gestational diabetes mellitus. A randomised controlled trial

Problem

Gestational diabetes mellitus, defined as any carbohydrate intolerance first diagnosed during pregnancy, is associated with a variety of adverse outcomes, both for the mother and her child.

Postnatal gestational diabetes mellitus follow-up: Perspectives of Australian hospital clinicians and general practitioners

Problem

The reasons for low postnatal screening rates for women with gestational diabetes mellitus are not well understood. Multiple care providers, settings and changes to diagnostic criteria, may contribute to confusion over postnatal care. Quality of communication between clinicians may be an important influence for the completion of postnatal gestational diabetes mellitus follow-up.

Traditional Chinese medicine perspective on constitution transformations in perinatal women: A prospective longitudinal study

BackgroundPregnancy is an important stage in life for many women. Humans are complex organisms that are prone to exhibiting gradual alterations in their constitutions that fluctuate with age, diet, and living environment. This is particularly true during the pre- and postnatal periods, in which qi and blood are required to ensure foetal growth.AimTo examine women's constitutional transformation of pre-pregnancy, pregnancy, and postpartum.MethodsA prospective, longitudinal study was conducted, and structural questionnaires were used to collect data. The participants were healthy pregnant women 21–49 years of age. Data were collected at six times: during the first (weeks 6–13), second (weeks 14–27), and third (weeks 28–40) trimesters and during the postnatal admission (1-week postnatal) and home self-care (6-week and 6-month postnatal) periods, yielding 86 valid questionnaires. A cubic polynomial regression analyses with generalised estimation equations (GEEs) method was used to reveal the trend of constitution score by different constitutions.FindingsSignificant differences (p < .0001) for the scores of Yang-Xu (yang-deficiency), Yin-Xu (yin-deficiency), and Tan-Shi-Yu-Zhi (phlegm-dampness and blood-stasis) constitutions were observed at pre-pregnancy, pregnancy, and 6 months postpartum. A least significant difference test showed that the scores obtained in the pregnancy period and at 6 months postpartum were higher than those of pre-pregnancy, indicating mitigated constitutional imbalance during postpartum. The highest scores of the Yang-Xu and Tan-Shi-Yu-Zhi constitutions occurred in the first trimester (36.02 ± 8.00 vs. 30.00 ± 7.21), and the highest scores of Yin-Xu constitution occurred in the third trimester (32.95 ± 7.48). The lowest scores of the Yang-Xu constitution were obtained at 6 months postpartum (25.24 ± 5.63) and during pre-pregnancy (25.26 ± 4.82), and those of the Yin-Xu and Tan-Shi-Yu-Zhi constitutions were observed in the pre-pregnancy (25.48 ± 4.46 vs. 19.94 ± 3.09). The 6-month postnatal scores of the Yang-Xu constitution nearly recovered to the prenatal level, whereas those of the other two constitutions did not.ConclusionThe results indicate that women's constitutions underwent changes throughout the perinatal stages. These findings provide a valuable reference for healthcare professionals in administering perinatal care and demonstrate empirical evidence for use in future intervention-based research.     

Reasons for substance use continuation and discontinuation during pregnancy: A qualitative study

Background

Substance use during pregnancy is a major public health concern, stemming from potential physical and psychosocial harms to both the mother and child.

The nutrition-related information seeking behaviours and attitudes of pregnant women with a high BMI: A qualitative study

BackgroundThe prevalence of high body mass index is increasing amongst women of child bearing age. High maternal body mass index has ramifications for both mother and baby including increased health risks from gestational diabetes mellitus, caesarean section and stillbirth. Despite the increasing prevalence of high maternal body mass index little is known of the experiences of these women regarding nutrition information access and use during the antenatal period.MethodsA qualitative study using individual interviews was undertaken at a tertiary hospital in south-eastern Australia. Twenty-Eight women with a body mass index ≥30 kg/m² participated. Interviews were audio recorded, transcribed, cross-checked for consistency and entered into a word processing document for further scrutiny. Data was analysed using interpretative phenomenological analysis (IPA). In any phenomenological study the researcher’s objective is to elicit the participant’s views on their lived experiences.FindingsThree major themes emerged: (1) Nutrition-related information attainment; (2) Nutrition-related information management; (3) Nutrition-related information needs and wants.ConclusionThe findings from this study may assist the future development and dissemination of nutrition-related information for pregnant women with a high body mass index. Women want more individualised support regarding nutritional requirements during pregnancy.     

Factors associated with breastfeeding to 3 months postpartum among women with type 1 and type 2 diabetes mellitus: An exploratory study

ProblemBreastfeeding has significant health benefits for maternal and infant health, yet women with pre-pregnancy diabetes (type 1 or type 2 diabetes mellitus) are often less likely to breastfeed compared with other childbearing women.BackgroundIntention to breastfeed and making the decision to breastfeed during pregnancy are significant predictors of breastfeeding in the general population, but intention to breastfeed has not been assessed during pregnancy among women with pre-pregnancy diabetes.AimTo investigate factors associated with breastfeeding to three months postpartum, including demographic, health and reproductive characteristics, perceived support and pre-birth intention to breastfeed, among women with pre-pregnancy diabetes.MethodsA prospective cohort of women with pre-pregnancy diabetes was recruited at three metropolitan hospitals in Melbourne, Australia. Women completed surveys during the third trimester of pregnancy (including intention to breastfeed) and at approximately 3 months postpartum (including current breastfeeding). Factors associated with any breastfeeding at 3 months postpartum were investigated using logistic regression.FindingsPregnancy surveys were completed by 79 women; three-month postpartum data were available for 47 women. Of these, more than two-thirds (n = 32, 68%) indicated that they were breastfeeding. Controlling for other relevant variables, only pre-birth intention to breastfeed was significantly associated with any breastfeeding at three months (Adjusted Odds Ratio (95% confidence intervals, p) = 20.49 (20.18–20.80, 0.017)).DiscussionPre-birth intention to breastfeed was the only significant predictor of continued breastfeeding to 3 months postpartum.ConclusionPregnancy provides an important opportunity for health professionals to educate and support women with pre-pregnancy diabetes about their breastfeeding intentions.     

Exploring outcomes for women and neonates having skin-to-skin contact during caesarean birth: A quasi-experimental design and qualitative study

ProblemWomen having an elective caesarean birth are often separated from their babies at birth with newborns transferred to a postnatal ward with the significant other.BackgroundTwo midwives were employed in 2019 to provide skin-to-skin contact for women who planned for elective caesarean births in a public hospital in metropolitan New South Wales with 4000 births per year and a 39% CB rate (57.8% of these births being elective).AimTo compare the outcomes for women and their newborns on the effects of skin-to-skin contact at elective caesarean births within the first five minutes of birth to those who did not have skin-to-skin contact and to explore the lived experiences of women having skin-to-skin contact during their elective caesarean births.MethodsA quasi-experimental design study with a qualitative component of in-depth interviews. Quantitative analyses included independent t-tests, chi square and logistic regression. Thematic analysis was used for the qualitative data.FindingsIn the quantitative results, there was a reduction in the time to the first feed (t(100) = ?11.32, p < 0.001) (M = 38.9, SE = 20.7) (M = 124.9, SE = 50.1) and the first breastfeed (t(100) = ?5.2, p < 0.001) (M = 53.2, SE = 82.5) (M = 277, SE = 295.8) with increased breastfeeding on discharge for women that had skin-to-skin contact at caesarean birth in comparison to those who did not receive skin-to-skin contact χ2(1) = 10.22, p < 0.05. In the qualitative results, women who had skin-to-skin contact during their caesarean birth had a positive experience with improved bonding and reported less anxiety and depression than their previous caesarean birth.ConclusionThis study provides evidence of the benefits of skin-to-skin contact during a caesarean birth.     

Wula (Voices) of Aboriginal women on barriers to accepting smoking cessation support during pregnancy: Findings from a qualitative study

Aim

To gather Aboriginal women’s stories of smoking and becoming pregnant to identify the barriers in accepting smoking cessation support during pregnancy.

Quality of life in retirement: A case study of Zulu return migrants

The quality of late life in technologically advanced societies has been well-researched. In contrast, very little systematic research has been conducted among the aged in less developed societies. An interesting case of retirement in a society in transition is that of returning Zulu contract workers. The apartheid laws of South Africa constrain migrant movements: contract workers typically spend their working lives in the urban-industrial milieu of the core economy and later return to a rural lifestyle in their areas of origin in the peripheral “homelands”. The retirement circumstances of 253 male return migrants in five rural areas of KwaZulu were assessed in an in-depth study. The subjective well-being of the Zulu retirees was found to be influenced mainly by such factors as health, perceived financial security, social activity and participation, and positive sentiment towards retirement life. The conclusion is drawn that migrant workers’ needs in retirement have a universal quality. This finding has social welfare policy implications in a society which is characterised by unequal distribution of privilege.