Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Chronic Diseases Initiative for Africa (CDIA), Cape Town, South Africa.
BMC Womens Health. 2020 Oct 12;20(1):231. doi: 10.1186/s12905-020-01093-4.
The diagnosis of gestational diabetes mellitus (GDM) may affect women's mental wellbeing, functioning and quality of life, with potentially negative effects on treatment adherence. Identifying and addressing the psychological and emotional needs of women with GDM, could have benefits for sustainable long-term behavioural change following the affected pregnancy. This study explored the lived experiences of women with GDM and the impact of GDM on their experience of pregnancy and sense of well-being.
Purposive sampling was used to recruit women who had been diagnosed with GDM in their previous pregnancy and received antenatal care at a tertiary hospital in Cape Town, South Africa. This was a descriptive qualitative study using a combination of focus groups and in-depth interviews for an in- depth exploration of women's lived experiences of GDM, their context and perceived needs. Data analysis followed an iterative thematic analysis approach.
Thirty-five women participated in nine focus groups and five in-depth interviews. Women discussed the emotional and psychological burden of having GDM, highlighting (i) their initial emotional reactions to receiving a GDM diagnosis, (ii) their experience of adjusting to the constraints of living with GDM (iii) their feelings of apprehension about childbirth and their maternal role and (iv) their feelings of abandonment in the post-partum period once the intensive support from both health system and family ends.
The current biomedical model used in the management of GDM, is highly foetal-centric and fails to acknowledge important psychological factors that contribute to women's overall wellbeing and experience of pregnancy. These results demonstrate the importance of incorporating mental health support in the management and care for women with GDM in public health services, along with facilitating emotional support from partners and family members. Based on our findings, we recommend routine mental health and psychosocial vulnerability screening and monitoring for women diagnosed with GDM throughout pregnancy and postpartum to improve prognoses.
妊娠糖尿病（GDM）的诊断可能会影响女性的心理健康、功能和生活质量，并可能对治疗依从性产生负面影响。识别和满足 GDM 女性的心理和情感需求，可能会对受影响妊娠后的可持续长期行为改变产生益处。本研究探讨了 GDM 女性的生活经历以及 GDM 对其妊娠体验和幸福感的影响。
采用目的抽样法招募了在以前的妊娠中被诊断为 GDM 并在南非开普敦的一家三级医院接受产前护理的女性。这是一项描述性定性研究，结合使用焦点小组和深入访谈，深入探讨了女性对 GDM 的生活经历、背景和感知需求。数据分析遵循迭代主题分析方法。
35 名女性参加了 9 个焦点小组和 5 个深入访谈。女性讨论了患有 GDM 的情绪和心理负担，强调了（i）她们最初对 GDM 诊断的情绪反应，（ii）她们适应患有 GDM 的限制的经历，（iii）她们对分娩和母性角色的担忧，以及（iv）一旦来自健康系统和家庭的强化支持结束，她们在产后阶段感到被抛弃。
目前在 GDM 管理中使用的生物医学模式高度以胎儿为中心，未能承认对女性整体幸福感和妊娠体验有贡献的重要心理因素。这些结果表明，在公共卫生服务中，将心理健康支持纳入 GDM 女性的管理和护理中非常重要，同时还需要促进伴侣和家庭成员的情感支持。基于我们的发现，我们建议在整个妊娠和产后期间对诊断为 GDM 的女性进行常规心理健康和心理社会脆弱性筛查和监测，以改善预后。
