Women's experience of diabetes and diabetes management in pregnancy: a systematic review of qualitative literature

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Executive summaryBackgroundPre-existing medical conditions, or medical conditions developing during pregnancy, may have an effect on pregnancy outcomes or conversely may be affected by the pregnancy. Pre-existing or gestational diabetes mellitus are such conditions. Generally, convention suggests that good control can assist to mitigate the negative effects of these conditions.Qualitative research is necessary to better inform health care workers and to help them understand the experiences of pregnant women with diabetes and how the experience may influence their attitudes to treatment. Some issues identified in the literature include shock at the time of diagnosis (both of gestational diabetes and pregnancy in the woman with preexisting diabetes), fear for the unborn child, and the importance of timely and appropriate professional and personal support. There is a worthwhile qualitative literature base focusing on the patient experience of diabetes in pregnancy. As there is no current qualitative synthesis of the literature it is timely and worthwhile to produce a systematic review to identify and summarize the existing qualitative literature exploring women's experiences of diabetes and diabetes management in pregnancy.ObjectivesTo identify and describe from available literature the experiences of pregnant women with pre-existing or gestational diabetes and their experiences of adhering (or not) to prescribed treatment regimes.Inclusion criteriaStudies that were qualitative in design that included currently pregnant women who had pre-existing diabetes mellitus or gestational diabetes mellitus.Search strategyThe search strategy aimed to find both published and unpublished studies and was conducted on 22 and 23 October 2012. No time limits were imposed in this search strategy. A three-step search strategy was utilized in this review.Methodological qualityAll studies that met the inclusion criteria were selected for retrieval. They were subsequently assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (QARI).Data extractionData was extracted from the papers included in the review using standardized critical appraisal instruments from the Joanna Briggs Institute QARI.Data synthesisResearch findings were pooled using the Joanna Briggs Institute QARI.ResultsFollowing the search and critical appraisal process, 22 studies were identified that were assessed as being of suitable quality to be included in the review. From these 22 studies a total of 174 study findings were included in the categories. A total of six categories were created on the basis of similarities of meaning, and from these, two synthesized findings (meta-synthesis) were produced. These were synthesized finding 1: Health professionals should be aware that their attitudes and practices in the care of women with diabetes during pregnancy needs to be empathetic and based upon a collaborative model of care, and synthesized finding 2: Women with perceived low compliance need time to adjust and education; these are major factors positively affecting women's motivation for adherence to treatment for diabetes in pregnancy.ConclusionsThe findings of this review highlight the need for health professionals to recognize that pregnant women's experiences of their medical conditions and treatments can affect their adherence to treatment regimes and hence their continued health and perinatal outcomes. Health professionals also need to acknowledge that both the medical condition and pregnancy are only part of women's complex lives and that treatment regimes should accommodate this as far as possible. Treatment of the pregnant diabetic involves a number of different health professionals and it is important that these professions work in synchrony and appointments made in a timely and appropriate time frame.

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