Psychosocial issues of women with type 1 diabetes transitioning to motherhood: a structured literature review

Abstract

BackgroundLife transitions often involve complex decisions, challenges and changes that affect diabetes management. Transition to motherhood is a major life event accompanied by increased risk that the pregnancy will lead to or accelerate existing diabetes-related complications, as well as risk of adverse pregnancy outcomes, all of which inevitably increase anxiety. The frequency of hyperglycaemia and hypoglycaemia often increases during pregnancy, which causes concern for the health and physical well-being of the mother and unborn child. This review aimed to examine the experiences of women with T1DM focusing on the pregnancy and postnatal phases of their transition to motherhood.MethodsThe structured literature review comprised a comprehensive search strategy identifying primary studies published in English between 1990–2012. Standard literature databases were searched along with the contents of diabetes-specific journals. Reference lists of included studies were checked. Search terms included: ‘diabetes’, ‘type 1’, ‘pregnancy’, ‘motherhood’, ‘transition’, ‘social support’, ‘quality of life’ and ‘psychological well-being’.ResultOf 112 abstracts returned, 62 articles were reviewed in full-text, and 16 met the inclusion criteria. There was a high level of diversity among these studies but three common key themes were identified. They related to physical (maternal and fetal) well-being, psychological well-being and social environment. The results were synthesized narratively.ConclusionWomen with type 1 diabetes experience a variety of psychosocial issues in their transition to motherhood: increased levels of anxiety, diabetes-related distress, guilt, a sense of disconnectedness from health professionals, and a focus on medicalisation of pregnancy rather than the positive transition to motherhood. A trusting relationship with health professionals, sharing experiences with other women with diabetes, active social support, shared decision and responsibilities for diabetes management assisted the women to make a positive transition. Health professionals can promote a positive transition to motherhood by proactively supporting women with T1DM in informed decision-making, by facilitating communication within the healthcare team and co-ordinating care for women with type 1 diabetes transitioning to motherhood.

Reprioritizing life: a conceptual model of how women with type 1 diabetes deal with main concerns in early motherhood

“…Women with type 1 diabetes mellitus (T1DM) encounter major challenges during their transitional period to motherhood (Rasmussen et al, 2013). This is related to the increased risks for the expected child, including malformations, accelerated gestational weight, and adverse outcomes during childbirth and the neonatal period (Inkster et al, 2006; Kinsley, 2007; Persson, Norman, & Hanson, 2009).…”

“…This is related to the increased risks for the expected child, including malformations, accelerated gestational weight, and adverse outcomes during childbirth and the neonatal period (Inkster et al, 2006; Kinsley, 2007; Persson, Norman, & Hanson, 2009). To minimize the risks, the women during pregnancy have to struggle for normoglycaemia more or less 24 hours a day, 7 days a week, and are often filled with worries, pressure, and guilt for not living optimally (Berg & Honkasalo, 2000; Rasmussen et al, 2013). During pregnancy, they are usually provided frequent follow-up at the antenatal clinic, and their glycaemic control is thoroughly monitored in order to deliver a healthy baby.…”

Postpartum Care of Women Affected by Diabetes: A Review of Current Trends

“…Some women report that they found useful information and social support via the internet [1,24]. Online forums and blogs can be a wealth of information, create a virtual support network, and link patients to experts; however, one caveat is that the patient must be able to evaluate the credibility of websites.…”

Preconception Care in Pre-gestational Diabetes

“…Transition to motherhood is a major life-changing event and is a common cause of stress and anxiety in all women but more so in women with pre-existing diabetes. Specific stressors include diabetes-related distress such as intensification of glucose control, fear of hypoglycemia, guilt and fear of passing diabetes to the child, and sense of disconnection with health care professionals [7]. It is of paramount importance that health care professionals recognize, acknowledge, and provide continuous support to women during all phases of this transition period.…”

“…The British National Institute for Health and Clinical Excellence (NICE) recommend an even lower HbA1c <6.5%, if this is safely achievable [7]. Women with diabetes who are planning to become pregnant may be offered monthly measurement of their HbA1c level.…”