Abstract
BackgroundWomen with gestational diabetes mellitus (GDM) have a tenfold increased risk of developing diabetes, and a high risk of recurrent GDM. Endorsing the life-course approach, aiming to prevent disease and promote health across generations, the Norwegian GDM guideline recommends follow-up in primary care after delivery, with information on the increased risks, lifestyle counselling, and annual diabetes screening. Few reports exist on Norwegian women’s experiences of GDM follow-up.AimTo elucidate women’s experiences with follow-up of GDM in pregnancy and after delivery, and to explore their attitudes to diabetes risk and motivation for lifestyle changes.Design & settingQualitative study in primary care in the region of Stavanger, Norway.MethodSemi-structured in-depth interviews were conducted 24–30 months after delivery with 14 women aged 28–44 years, with a history of GDM. Data were analysed thematically.ResultsMost women were satisfied with the follow-up during pregnancy; however, only two women were followed-up according to the guideline after delivery. In most encounters with GPs after delivery, GDM was not mentioned. To continue the healthy lifestyle adopted in pregnancy, awareness of future risk was a motivational factor, and the women asked for tailored information on individual risk and improved support. The main themes emerging from the analysis were as follows: stigma and shame; uncertainty; gaining control and finding balance; and a need for support to sustain change.ConclusionWomen experienced a lack of support for GDM in Norwegian primary care after delivery. To maintain a healthy lifestyle, women suggested being given tailored information and improved support.
Highlights
Hyperglycemia, affecting one in six live births worldwide, is a common medical complication in pregnancy and should be classified as either diabetes mellitus in pregnancy (DIP) or gestational diabetes mellitus (GDM) [1]
In Norway, a continuity of care is ensured by the general practitioners (GPs) being responsible for follow-up before, during and after pregnancy, as implemented in a new national guideline
Uncertainty, stigma and shame were among the feelings associated with GDM, and the mothers ask for improved support to sustain change and maintain the healthy lifestyle adopted in pregnancy
Summary
Hyperglycemia, affecting one in six live births worldwide, is a common medical complication in pregnancy and should be classified as either diabetes mellitus in pregnancy (DIP) or gestational diabetes mellitus (GDM) [1]. The prevalence of GDM is higher than in Norwegian women, and the risk of GDM increases with years of residence [3]. Women with prior GDM have a tenfold increased risk of being diagnosed with type 2 diabetes mellitus (T2DM) later on [5], and within 15 years postpartum, a third of women with GDM have been diagnosed with T2DM [6]. Women with gestational diabetes mellitus (GDM) have a tenfold increased risk of developing diabetes, and a high risk of recurrent GDM. Endorsing the life-course approach aiming to prevent disease and promote health across generations, the Norwegian GDM guideline recommends follow-up in primary care after delivery, with information on the increased risks, lifestyle counselling and annual diabetes screening. Aim: To elucidate women’s experiences with follow-up of GDM in pregnancy and after delivery, and to explore their attitudes to diabetes risk and motivation for lifestyle changes. Uncertainty, stigma and shame, gaining control and finding balance and a need for support to sustain change were the main themes emerging from the analysis
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