Type 1 diabetes and pregnancy: a phenomenological study of women's first experiences

Abstract

The aims of this study were to explore women's perceptions and experiences of being pregnant and having pre-existing type 1 diabetes mellitus, and to assess their physical, social, psychological, emotional and educational needs during their transition to motherhood.The qualitative design incorporated a purposive sample of seven women in their first pregnancy, who participated in one-to-one interviews with a researcher at 15-20 and 32-36 weeks gestation, and at 6-8 weeks post-partum.Qualitative analysis identified seven key themes from the data including: knowledge; physical and psychological impact; control and trust; catalyst to action; organisation of care and communication; attendance and intervention; expectations and systems.This study has shown that most women with diabetes who become pregnant are resigned to the fact that their pregnancy is considered high risk, and are willing to play their part to achieve a positive pregnancy outcome. However, they would also like to 'do the normal pregnant bit as well', 'normalise it and make it a nice experience' and make it feel 'less fragmented'. This woman-centred experience of pregnancy care, in women with type 1 diabetes mellitus, may motivate health professionals to revise their approach to care, prompt them to utilise the skills of each individual member of the multidisciplinary team to its full strength and potential, and assist in the provision of a positive, balanced and more holistic approach to care, specific to this client group.

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

“…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.…”

“…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. 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.…”

“…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.…”

“…The studies varied considerably in size, reflecting the fact that some studies adopted a mixed-methods approach. The number of participants included in the studies reporting on women's experience ranged from only seven, 43 to 107. 41 A wider range is seen in the studies reporting the experiences of health-care practitioners, which ranged from 15 36 to 510 practitioners.…”

“…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.…”