Women's and healthcare providers' perceptions of long-term complications associated with hypertension and diabetes in pregnancy: a qualitative study.

J Hirst,R Norton,S Kennedy,S Nagraj,L Hinton,D Praveen

doi:10.1111/1471-0528.15847

Abstract

ObjectivesA diagnosis of hypertensive disorders during pregnancy (HDPs) or gestational diabetes mellitus (GDM) is highly predictive of women at increased risk of developing chronic hypertension, Type 2 diabetes, and cardiovascular disease. This study investigates perceptions of women and healthcare providers in rural India regarding these long‐term risks.DesignQualitative study using modified grounded theory.SettingTwo states in rural India: Haryana and Andhra Pradesh.PopulationPregnant and postpartum women, community health workers (CHWs), primary care physicians, obstetricians, laboratory technicians, and healthcare officials.MethodsIn‐depth interviews and focus group discussions explored: (1) priorities for high‐risk pregnant women; (2) detection and management of HDPs and GDM; (3) postpartum management, and (4) knowledge of long‐term sequelae of high‐risk conditions. A thematic analysis was undertaken.ResultsSeven focus group discussions and 11 in‐depth interviews (n = 71 participants) were performed. The key priority area for high‐risk pregnant women was anaemia. Blood pressure measurement was routinely embedded in antenatal care; however, postpartum follow up and knowledge of the long‐term complications were limited. GDM was not considered a common problem, although significant variations and challenges to GDM screening were identified. Knowledge of the long‐term sequelae of GDM with regard to an increased risk of Type 2 diabetes and cardiovascular disease among doctors was minimal.ConclusionsThere is a need for improved education, standardisation of testing and postpartum follow up of HDPs and GDM in rural Indian settings.Funding SN is supported by an MRC Clinical Research Training Fellowship (MR/R017182/1). The George Institute for Global Health Global Women's Health programme provided financial support for the research assistant and fieldwork costs in India.Tweetable abstractImproved education and postpartum care of women with hypertension and diabetes in pregnancy in rural India are needed to prevent long‐term risks.

Highlights

India is undergoing a major epidemiological transition towards non-communicable diseases (NCDs).[1]
Women with pre-eclampsia have an almost four-fold risk a 2019 The Authors BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of
District government representatives responsible for healthcare in the state were approached through The George Institute for Global Health (TGI) in Delhi and Hyderabad, for Haryana and Andhra Pradesh, respectively

Summary

Introduction

India is undergoing a major epidemiological transition towards non-communicable diseases (NCDs).[1] Cardiovascular disease (CVD) accounts for most deaths[2]; onset is typically early,[3] and case fatality rates are high.[4,5] CVD is the leading cause of death in women in India.[6] Pregnancyrelated conditions such as pre-eclampsia and gestational diabetes mellitus (GDM) are associated with significant perinatal mortality and morbidity,[7,8] and carry independent risks for future cardiometabolic disorders in mothers.[9,10,11,12,13]. Women with pre-eclampsia have an almost four-fold risk a 2019 The Authors BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of.

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