Perspectives on the psychological and emotional burden of having gestational diabetes amongst low-income women in Cape Town, South Africa

Abstract

Background The diagnosis of gestational diabetes mellitus (GDM) may affect women’s mental wellbeing, functioning and quality of life, with potentially negative effects on treatment adherence. Identifying and addressing the psychological and emotional needs of women with GDM, could have benefits for sustainable long-term behavioural change following the affected pregnancy. This study explored the lived experiences of women with GDM and the impact of GDM on their experience of pregnancy and sense of well-being. Methods Purposive sampling was used to recruit women who had been diagnosed with GDM in their previous pregnancy and received antenatal care at a tertiary hospital in Cape Town, South Africa. This was a descriptive qualitative study using a combination of focus groups and in-depth interviews for an in- depth exploration of women’s lived experiences of GDM, their context and perceived needs. Data analysis followed an iterative thematic analysis approach. Results Thirty-five women participated in nine focus groups and five in-depth interviews. Women discussed the emotional and psychological burden of having GDM, highlighting (i) their initial emotional reactions to receiving a GDM diagnosis, (ii) their experience of adjusting to the constraints of living with GDM (iii) their feelings of apprehension about childbirth and their maternal role and (iv) their feelings of abandonment in the post-partum period once the intensive support from both health system and family ends. Conclusions The current biomedical model used in the management of GDM, is highly foetal-centric and fails to acknowledge important psychological factors that contribute to women’s overall wellbeing and experience of pregnancy. These results demonstrate the importance of incorporating mental health support in the management and care for women with GDM in public health services, along with facilitating emotional support from partners and family members. Based on our findings, we recommend routine mental health and psychosocial vulnerability screening and monitoring for women diagnosed with GDM throughout pregnancy and postpartum to improve prognoses.

Barriers to and enablers of type 2 diabetes screening among women with prior gestational diabetes: A systematic review update and qualitative synthesis applying the Theoretical Domains Framework

“…An important barrier for women who have experienced complicated pregnancy, was the feeling of disappointment in the rapid reduction in attention and support by the health system after birth. In the context of gestational diabetes, this phenomenon is described as ‘postpartum abandonment’ 50 . While women's pregnancies were typically characterised by close monitoring and attention, education and communication, the postpartum experience was the opposite, leaving unanswered questions about follow‐up care, including type 2 diabetes screening.…”

“…Like, “OK, what am I supposed to do?”’ 69 . Some study authors observed that the perceived withdrawal of support hindered women's ability to maintain important behaviour changes 50 …”

“…In the context of gestational diabetes, this phenomenon is described as 'postpartum abandonment'. 50 While women's pregnancies were typically characterised by close monitoring and attention, education and communication, the postpartum experience was the opposite, leaving unanswered questions about follow-up care, including type 2 diabetes screening. One woman described the impact: 'You're kind of left on your own…it's kind of hard to elaborate on something like that…I feel I was abandoned.…”

Antenatal Care Experience In Pregnant Women With Gestational Diabetes

“…Based on the mapping results in this scoping review, the following findings were obtained: a. Antenatal Care Experience The experience of pregnant women with gestational diabetes related to psychology is very influential, especially the level of stress during pregnancy with health risks and financial barriers, especially in low and middle income countries (Muhwava et al, 2020). This is in accordance with research from (Rahayu & Rodiani, 2016) which says the experience of mothers with gestational diabetes is a health problem because this disease is directed at the mother and fetus.…”

Assessment of a short-course yoga practice on cardiometabolic risks, fetomaternal outcomes and psychophysical health in gestational diabetes mellitus

“…GDM may have negative impact on women's mental well-being and quality of life. Various psychological problems occur as an effect of GDM which includes anxiety, stress during pregnancy, antenatal and postpartum depression (10). Hyperglycemia could be both the cause and consequence of depression (11,12).…”