O'Higgins S, McGuire B E, Mustafa E, Dunne F
School of Psychology and Centre for Pain Research, National University of Ireland, Galway, Ireland.
Diabet Med. 2014 Mar;31(3):366-74. doi: 10.1111/dme.12370. Epub 2014 Jan 17.
Pre-pregnancy care programmes can help to reduce morbidity and mortality associated with pregnancy in women with diabetes. However, uptake of a free pre-pregnancy care programme along the Irish Atlantic seaboard was only 30%. This study sought to better understand why women with diabetes mellitus (Type 1 and Type 2) choose to attend pre-pregnancy care services and to identify perceived barriers to attendance.
A participative health research method called the participative research process was used to facilitate 14 women with diabetes mellitus to create 'webs of ideas' on the reasons for attendance and non-attendance at a pre-pregnancy care programme, and potential solutions for each obstacle.
The participants identified information on the risks of pregnancy as crucial for all childbearing women with diabetes, as lack of information was a major obstacle to attendance at pre-pregnancy care programmes. Practical constraints such as childcare difficulties and work commitments were also identified. Participants stressed that health practitioners need to focus on positive aspects of pregnancy and childbearing rather than focusing solely on the problematic aspects for women with diabetes mellitus.
Women with diabetes need support and reassurance about their ability to control blood glucose and have a successful pregnancy while coping with the multiple challenges inherent in diabetes management and pregnancy. To increase uptake of pre-pregnancy care, a norm needs to be established that situates pre-pregnancy care as something every woman with diabetes will do, whether or not she is actively contemplating becoming a mother at the time. Active use of social media and facilitating peer support should be encouraged in pre-pregnancy services to facilitate attendance. The time has come to incorporate the skills of a clinical psychologist in the delivery of a pre-pregnancy service.
孕前护理计划有助于降低糖尿病女性妊娠相关的发病率和死亡率。然而，爱尔兰大西洋沿岸免费孕前护理计划的参与率仅为30%。本研究旨在更好地了解1型和2型糖尿病女性选择参加孕前护理服务的原因，并找出她们认为的参与障碍。
采用一种名为参与式研究过程的参与性健康研究方法，帮助14名糖尿病女性就参加和不参加孕前护理计划的原因以及每个障碍的潜在解决方案创建“想法网络”。
参与者认为，对于所有患有糖尿病的育龄妇女来说，有关妊娠风险的信息至关重要，因为信息不足是参加孕前护理计划的主要障碍。还发现了诸如育儿困难和工作负担等实际限制因素。参与者强调，健康从业者需要关注妊娠和生育的积极方面，而不是只关注糖尿病女性面临的问题方面。
糖尿病女性在应对糖尿病管理和妊娠所固有的多重挑战时，需要在控制血糖能力和成功妊娠方面获得支持和安心。为了提高孕前护理的参与率，需要确立一种规范，即孕前护理是每个糖尿病女性都会做的事情，无论她当时是否积极考虑成为母亲。孕前服务应鼓励积极使用社交媒体并促进同伴支持，以方便女性参与。现在是时候将临床心理学家的技能纳入孕前服务的提供中了。
