Liggins Institute, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
Faculty of Health & Environmental Sciences, AUT, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
BMC Pregnancy Childbirth. 2018 Apr 11;18(1):91. doi: 10.1186/s12884-018-1710-8.
Glycaemic target recommendations vary widely between international professional organisations for women with gestational diabetes mellitus (GDM). Some studies have reported women's experiences of having GDM, but little is known how this relates to their glycaemic targets. The aim of this study was to identify enablers and barriers for women with GDM to achieve optimal glycaemic control.
Women with GDM were recruited from two large, geographically different, hospitals in New Zealand to participate in a semi-structured interview to explore their views and experiences focusing on enablers and barriers to achieving optimal glycaemic control. Final thematic analysis was performed using the Theoretical Domains Framework.
Sixty women participated in the study. Women reported a shift from their initial negative response to accepting their diagnosis but disliked the constant focus on numbers. Enablers and barriers were categorised into ten domains across the three study questions. Enablers included: the ability to attend group teaching sessions with family and hear from women who have had GDM; easy access to a diabetes dietitian with diet recommendations tailored to a woman's context including ethnic food and financial considerations; free capillary blood glucose (CBG) monitoring equipment, health shuttles to take women to appointments; child care when attending clinic appointments; and being taught CBG testing by a community pharmacist. Barriers included: lack of health information, teaching sessions, consultations, and food diaries in a woman's first language; long waiting times at clinic appointments; seeing a different health professional every clinic visit; inconsistent advice; no tailored physical activities assessments; not knowing where to access appropriate information on the internet; unsupportive partners, families, and workplaces; and unavailability of social media or support groups for women with GDM. Perceived judgement by others led some women only to share their GDM diagnosis with their partners. This created social isolation.
Women with GDM report multiple enablers and barriers to achieving optimal glycaemic control. The findings of this study may assist health professionals and diabetes in pregnancy services to improve their care for women with GDM and support them to achieve optimal glycaemic control.
国际专业组织对妊娠糖尿病（GDM）女性的血糖目标推荐差异很大。一些研究报告了女性患有 GDM 的经历，但对于这些经历与她们的血糖目标之间的关系知之甚少。本研究的目的是确定 GDM 女性实现最佳血糖控制的促进因素和障碍。
从新西兰两家地理位置不同的大型医院招募 GDM 女性参加半结构化访谈，以探讨她们对实现最佳血糖控制的看法和经验，重点关注促进因素和障碍。最终采用理论领域框架进行主题分析。
60 名女性参与了研究。女性报告说，她们从最初对诊断的负面反应转变为接受，但不喜欢一直关注数字。促进因素和障碍分为三个研究问题的十个领域。促进因素包括：能够与家人一起参加小组教学课程，并听取患有 GDM 的女性的意见；能够方便地获得糖尿病营养师的服务，营养师会根据女性的情况提供饮食建议，包括民族食物和经济考虑因素；免费提供毛细血管血糖（CBG）监测设备，健康班车接送女性就诊；在就诊时提供儿童保育服务；并由社区药剂师教授 CBG 测试。障碍包括：缺乏女性母语的健康信息、教学课程、咨询和饮食日记；在诊所就诊时等待时间长；每次就诊时都要看不同的卫生专业人员；建议不一致；没有量身定制的体育活动评估；不知道在哪里可以访问互联网上的适当信息；伴侣、家人和工作场所不支持；以及没有为 GDM 女性提供社交媒体或支持团体。其他人的判断导致一些女性只与伴侣分享她们的 GDM 诊断。这导致了社交孤立。
GDM 女性报告了实现最佳血糖控制的多个促进因素和障碍。本研究的结果可能有助于卫生专业人员和妊娠糖尿病服务改善对 GDM 女性的护理，并支持她们实现最佳血糖控制。
