Forde Rita, Patelarou Evridiki E, Forbes Angus
Department of Adult Nursing, Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.
Int J Womens Health. 2016 Dec 8;8:691-703. doi: 10.2147/IJWH.S115955. eCollection 2016.
Diabetes is one of the most common medical conditions affecting pregnancy and is associated with a number of adverse fetal, infant, and maternal outcomes. These adverse outcomes can be avoided or minimized with appropriate prepregnancy care (PPC). However, the uptake of PPC is limited in women with type 2 diabetes mellitus (T2DM). The reasons for poor uptake are multifactorial, reflecting both women's understanding of pregnancy risks, and limitations in care delivery.
A systematic literature review with meta-synthesis was undertaken to identify qualitative studies exploring experiences of PPC for women with T2DM incorporating the views of women with T2DM and health care professionals (HCPs). Identified studies included were synthesized in a meta-ethnography to develop an understanding of the elements contributing to the uptake of PPC among women with T2DM.
The systematic review identified seven studies yielding data from 28 women with T2DM and 83 HCPs. The following six third-order constructs were identified from the synthesis: understanding PPC, emotive catalysts, beliefs about reproduction among women with T2DM, relationships and social factors, HCP behaviors and perspectives, and health care system factors. These constructs were used to develop a multifactorial model expressing the interactive issues that shape the reproductive health-seeking behaviors of women with T2DM to identify potential areas for intervention.
The uptake of PPC among women with T2DM seems to be informed by their personal orientation to their reproductive needs, their interactions with HCPs, and system-level influences. Future interventions to enhance PPC uptake need to address these underlying issues.
糖尿病是影响妊娠最常见的医学病症之一，与许多不良胎儿、婴儿及母体结局相关。通过适当的孕前保健（PPC）可避免或减少这些不良结局。然而，2型糖尿病（T2DM）女性对孕前保健的接受程度有限。接受程度低的原因是多方面的，既反映了女性对妊娠风险的认知，也反映了医疗服务提供方面的局限性。
进行了一项系统文献综述并进行元综合分析，以确定探索T2DM女性孕前保健经历的定性研究，纳入了T2DM女性和医疗保健专业人员（HCPs）的观点。所纳入的已确定研究在元民族志中进行综合，以了解影响T2DM女性接受孕前保健的因素。
系统综述确定了7项研究，产生了来自28名T2DM女性和83名HCPs的数据。从综合分析中确定了以下六个三阶结构：了解孕前保健、情感催化剂、T2DM女性对生殖的信念、关系和社会因素、HCP行为和观点以及医疗保健系统因素。这些结构用于构建一个多因素模型，以表达塑造T2DM女性生殖健康寻求行为的互动问题，从而确定潜在的干预领域。
T2DM女性对孕前保健的接受程度似乎受其对生殖需求的个人取向、与HCPs的互动以及系统层面影响的影响。未来提高孕前保健接受度的干预措施需要解决这些潜在问题。
