University of Cambridge, Metabolic Research Laboratories, Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, UK.
Diabet Med. 2010 Jan;27(1):92-100. doi: 10.1111/j.1464-5491.2009.02890.x.
To explore the views of women who did not attend pre-pregnancy care (PPC), in particular their accounts of contraception, previous pregnancies and the influence of healthcare advice.
We conducted semi-structured interviews with 29 pregnant women (21 with Type 1 diabetes, eight with Type 2 diabetes) at three UK specialist diabetes antenatal clinics. Interviews explored women's journeys to becoming pregnant, including use of contraception, their views regarding diabetes and pregnancy and the factors which encouraged and discouraged them from attending PPC.
All women had some understanding of the issues concerning diabetes during pregnancy, predominantly regarding the benefits of PPC (90%) and optimal glycaemic control (80%) and risks of malformation (48%) and macrosomia (35%). Most were not regularly using contraception (70%), having stopped deliberately (45%), become unintentionally less rigorous (28%) or experienced side effects/contraindications (14%). Knowledge concerning the risks of pregnancy (90%) and past pre-conception counselling (38%) did not encourage women to attend PPC, and neither did personal experience of miscarriage, malformation or stillbirth in women with previous poor pregnancy outcome (41%). Barriers included conceiving faster than anticipated (45%), fertility concerns (31%), negative experiences with health professionals (21%), desire for a 'normal' pregnancy (17%) and the logistics of attending (10%).
More integrated diabetes and reproductive health/contraceptive advice, increased awareness of the potentially short time between stopping contraception and conception and more intensive support between pregnancies are required, particularly for women with previously poor outcomes. Research is also needed into how communication between health professionals and women with diabetes can be improved.
探讨未参加孕前保健 (PPC) 的女性的观点，特别是她们对避孕、既往妊娠以及医疗保健建议影响的看法。
我们在英国三个专门的糖尿病产前诊所对 29 名孕妇（21 名患有 1 型糖尿病，8 名患有 2 型糖尿病）进行了半结构式访谈。访谈内容包括女性怀孕的经历，包括避孕措施的使用、她们对糖尿病和怀孕的看法以及鼓励和劝阻她们参加 PPC 的因素。
所有女性都对怀孕期间与糖尿病相关的问题有一定的了解，主要是关于 PPC 的益处（90%）和最佳血糖控制（80%）以及畸形（48%）和巨大儿（35%）的风险。大多数女性没有定期使用避孕措施（70%），有故意停止（45%）、不那么严格（28%）或出现副作用/禁忌症（14%）。对怀孕风险（90%）和既往孕前咨询（38%）的了解并没有鼓励女性参加 PPC，既往妊娠结局不佳的女性经历过流产、畸形或死产（41%）也没有。障碍包括比预期更快地怀孕（45%）、生育问题（31%）、对卫生专业人员的负面经历（21%）、对“正常”怀孕的渴望（17%）和参加的后勤问题（10%）。
需要提供更综合的糖尿病和生殖健康/避孕咨询，提高对停止避孕和怀孕之间潜在短暂时间的认识，以及在怀孕之间提供更强化的支持，特别是对既往妊娠结局不佳的女性。还需要研究如何改善卫生专业人员与糖尿病女性之间的沟通。
