Experiences of professional support during pregnancy and childbirth – a qualitative study of women with type 1 diabetes

Berg, Marie; Sparud-Lundin, Carina

doi:10.1186/1471-2393-9-27

Cited by 56 publications

(93 citation statements)

References 21 publications

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“…The full citations of the studies that were excluded from the review are given in Appendix 3. Of the 18 studies that were included (which are described in detail in Table 2), 13 [26][27][28][30][31][32][33][34]37,38,40,42,43 addressed the experiences and perceptions of women only, four 29,35,36,39 addressed the experiences and perceptions of healthcare practitioners only and one study 41 addressed the experiences and perceptions of women and practitioners. It is of note that there are relatively few studies that have explored the views of practitioners responsible for providing care to women with diabetes mellitus in pregnancy.…”

Section: Summary Of Included Studiesmentioning

confidence: 99%

“…The largest majority of studies (n = 9) 30,33,34,36,37,[40][41][42][43] were based in a UK context, six [27][28][29]31,35,39 were based in the USA and one study each was based in Australia, 32 Ireland 38 and Sweden. 26 The study based in Australia 32 is distinct because it focused specifically on the experiences of women living in rural and relatively isolated communities. Of the 14 studies that addressed the experiences or perceptions of women, eight 27,28,31,33,37,38,41,42 included both women with T1DM and those with T2DM and six 26,30,32,34,40,43 included only women with T1DM.…”

Section: Summary Of Included Studiesmentioning

confidence: 99%

“…26 The study based in Australia 32 is distinct because it focused specifically on the experiences of women living in rural and relatively isolated communities. Of the 14 studies that addressed the experiences or perceptions of women, eight 27,28,31,33,37,38,41,42 included both women with T1DM and those with T2DM and six 26,30,32,34,40,43 included only women with T1DM. There were no studies that focused solely on the experiences of women with T2DM.…”

Section: Summary Of Included Studiesmentioning

confidence: 99%

“…39 Participants were predominantly recruited from secondary care but some studies reported use of other settings. Twelve studies 26,30,31,33,34,[36][37][38][40][41][42][43] were located in secondary care and only one 36 in both primary and secondary care. The study that recruited from primary care did so in order to recruit general practitioners (GPs) to the study.…”

Section: Summary Of Included Studiesmentioning

confidence: 99%

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Preconception care for women with type 1 or type 2 diabetes mellitus: a mixed-methods study exploring uptake of preconception care

Earle

Tariq

Komaromy

et al. 2017

Health Technol Assess

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BackgroundDiabetes mellitus is a global health problem and one of the most common medical conditions in pregnancy. A wide range of modifiable risk factors are associated with diabetes mellitus in pregnancy, and it is widely acknowledged that preconception care (PCC) is beneficial for women with pre-existing diabetes mellitus. However, uptake of PCC services is low.ObjectivesTo systematically review qualitative research on PCC for women with pre-existing diabetes mellitus of childbearing age, identify facilitators of and barriers to uptake of PCC and establish themes and gaps in knowledge. Through qualitative interviews explore views on the provision of, and facilitators of and barriers to the uptake of, PCC.DesignMixed methods encompassing a systematic review and qualitative interviews.SettingTwo secondary care sites and 11 primary care sites.ParticipantsWomen of childbearing age with pre-existing type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) of white British or Pakistani origin.InterventionsNone.AnalysisA narrative synthesis of the literature using thematic analysis and a thematic analysis of the qualitative interview data using the method of constant comparison.ResultsEighteen qualitative studies were included in the systematic review and a quality appraisal was carried out using relevant criteria for qualitative research appraisal, including a narrative summary of study quality. Twelve interviews with women with pre-existing T1DM or T2DM were carried out. This fell short of the original aim of interviewing 48 women owing to challenges in recruitment, especially in primary care. A synthesis of these data shows that uptake of PCC is influenced by a range of factors, including the complexity of pregnancy planning, the skill and expertise of health professionals who provide care to women with diabetes mellitus, the role of health professionals in the delivery of PCC, and the quality of relationships between women and health professionals.LimitationsOwing to significant challenges with recruitment of participants, particularly in primary care, 12 interviews with women with pre-existing T1DM or T2DM were carried out, which fell short of the a priori sample size.ConclusionsReconceptualising PCC to place greater emphasis on pregnancy planning, fertility and contraception would lower some of the existing barriers to uptake of care. It is important to clarify who is responsible for the delivery of PCC to women with pre-existing diabetes mellitus and to ensure that the correct expertise is available so that opportunities for advice giving are maximised. Relationships between women and health professionals should be based on a partnership approach that encourages mutual trust and respect, focusing on positive change rather than negative outcomes.Future workFurther research is needed to investigate the views and experiences of stakeholders that commission, design and deliver PCC services for women with pre-existing diabetes mellitus; to explore experiences of women from minority or ethnically diverse backgrounds; to investigate the role of family support in contraception, pregnancy planning and PCC; and to investigate the management of diabetes mellitus in neonatal care and its role in breastfeeding.Study registrationThis study is registered as PROSPERO CRD42014015592 and ISRCTN12983949.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Summary Of Included Studiesmentioning

confidence: 99%

Section: Summary Of Included Studiesmentioning

confidence: 99%

Section: Summary Of Included Studiesmentioning

confidence: 99%

Section: Summary Of Included Studiesmentioning

confidence: 99%

See 2 more Smart Citations

Preconception care for women with type 1 or type 2 diabetes mellitus: a mixed-methods study exploring uptake of preconception care

Earle

Tariq

Komaromy

et al. 2017

Health Technol Assess

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“…8 For women who continue managing their own insulin delivery, the burden of frequent monitoring and insulin dose adjustments can be stressful. 9 A hybrid closed-loop system uses a continuous glucose monitor (CGM), CSII, and computer algorithm to provide automated glucose-responsive insulin delivery. In pregnancy, it has been shown to improve overnight time in target and safely maintain effective glucose control with less hypoglycemia compared with sensor-augmented pump (SAP) therapy.…”

Section: Introductionmentioning

confidence: 99%

Adaptability of Closed-Loop during Labor, Delivery, and Postpartum—A Secondary Analysis of Data From Two Randomized Crossover Trials in Type 1 Diabetes Pregnancy

Yamamoto¹,

Stewart²,

Wilinska³

et al. 2018

Diabetes

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Tight glucose control during labor and delivery is recommended for pregnant women with type 1 diabetes. This can be challenging to achieve using the current treatment modalities. The automated nature of closed loop and its ability to adapt to real-time glucose levels make it well suited for use during labor, delivery, and the immediate postpartum period. We report observational data of participants from two randomized crossover trials who chose to continue using closed loop during labor, delivery, and postpartum. Labor was defined as the 24 h before delivery and postpartum as the 48 h after delivery. The glucose target range during pregnancy was 3.5-7.8 mmol/L (63-140 mg/dL) and 3.9-10 mmol/L (70-180 mg/dL) after delivery. Twenty-seven (84.4%) of the potential 32 trial participants used closed loop through labor, delivery, and postpartum. Use of closed loop was associated with 82.0% (interquartile range [IQR] 49.3, 93.0) time-in-target range during labor and delivery and a mean glucose of 6.9 -1.4 mmol/L (124 -25 mg/dL). Closed loop performed well throughout vaginal, elective, and emergency cesarean section deliveries. Postpartum, women spent 83.3% (IQR 75.2, 94.6) time-intarget range (3.9-10.0 mmol/L [70-180 mg/dL]), with a mean glucose of 7.2 -1.4 mmol/L (130 -25 mg/dL). There was no difference in maternal glucose concentration between mothers of infants with and without neonatal hypoglycemia (6.9 -1.6 mmol/L and 6.8 -1.1 mmol/L [124 -29 mg/dL and 122 -20 mg/dL] respectively; P = 0.84). Automated closed-loop insulin delivery is feasible during hospital admissions for labor, delivery, and postpartum. Larger scale studies are needed to evaluate its efficacy compared with current clinical approaches as well as understand how women and healthcare providers will adopt this technology.

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Implications for the Mother with Diabetes

Wender-Ożegowska

Sacks

2017

A Practical Manual of Diabetes in Pregnancy

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Experiences of professional support during pregnancy and childbirth – a qualitative study of women with type 1 diabetes

Cited by 56 publications

References 21 publications

Preconception care for women with type 1 or type 2 diabetes mellitus: a mixed-methods study exploring uptake of preconception care

Preconception care for women with type 1 or type 2 diabetes mellitus: a mixed-methods study exploring uptake of preconception care

Adaptability of Closed-Loop during Labor, Delivery, and Postpartum—A Secondary Analysis of Data From Two Randomized Crossover Trials in Type 1 Diabetes Pregnancy

Implications for the Mother with Diabetes

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