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Preeclampsia, gestational diabetes and later risk of cardiovascular disease: Women's experiences and motivation for lifestyle changes explored in focus group interviews.

ABSTRACT: BACKGROUND:Preeclampsia (PE) and gestational diabetes mellitus (GDM) are both associated with increased risk of future cardiovascular disease (CVD). Knowledge of the relationship between these pregnancy complications and increased CVD risk enables early prevention through lifestyle changes. This study aimed to explore women's experiences with PE and/or GDM, and their motivation and need for information and support to achieve lifestyle changes. METHODS:Systematic text condensation was used for thematic analysis of meaning and content of data from five focus group interviews with 17 women with PE and/or GDM, with a live birth between January 2015 and October 2017. RESULTS:This study provides new knowledge of how women with GDM and/or PE experience pregnancy complications in a Nordic healthcare model. It reveals the support they want and the important motivating factors for lifestyle change. We identified six themes: Trivialization of the diagnosis during pregnancy; Left to themselves to look after their own health; The need to process the shock before making lifestyle changes (severe PE); A desire for information about future disease risk and partner involvement; Practical solutions in a busy life with a little one, and; Healthcare professionals can reinforce the turning point. The women with GDM wanted healthcare professionals to motivate them to continue the lifestyle changes introduced during pregnancy. Those with severe PE felt a need for individualized care to ensure that they had processed their traumatic labor experiences before making lifestyle changes. Participants wanted their partner to be routinely involved to ensure a joint understanding of the need for lifestyle changes. Motivation for lifestyle changes in pregnancy was linked to early information and seeing concrete results. CONCLUSIONS:Women with PE and GDM have different experiences of diagnosis and treatment, which will affect the follow-up interventions to reduce future CVD risk through lifestyle change. For GDM patients, lifestyle changes in pregnancy should be reinforced and continued postpartum. Women with PE should be informed by their general practitioner after birth, and given a plan for lifestyle change. Those with severe PE will need help in processing the trauma, and stress management should be routinely offered.

SUBMITTER: Sandsæter HL

PROVIDER: S-EPMC6882194 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Preeclampsia, gestational diabetes and later risk of cardiovascular disease: Women's experiences and motivation for lifestyle changes explored in focus group interviews.

Sandsæter Heidi L HL Horn Julie J Rich-Edwards Janet W JW Haugdahl Hege S HS

BMC pregnancy and childbirth 20191127 1

<h4>Background</h4>Preeclampsia (PE) and gestational diabetes mellitus (GDM) are both associated with increased risk of future cardiovascular disease (CVD). Knowledge of the relationship between these pregnancy complications and increased CVD risk enables early prevention through lifestyle changes. This study aimed to explore women's experiences with PE and/or GDM, and their motivation and need for information and support to achieve lifestyle changes.<h4>Methods</h4>Systematic text condensation ...[more]

PMID: 31775681

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Project description:BACKGROUND:Gestational diabetes mellitus (GDM) - a transitory form of diabetes induced by pregnancy - has potentially important short and long-term health consequences for both the mother and her baby. There is no globally agreed definition of GDM, but definition changes have increased the incidence in some countries in recent years, with some research suggesting minimal clinical improvement in outcomes. The aim of this qualitative systematic review was to identify the psychosocial experiences a diagnosis of GDM has on women during pregnancy and the postpartum period. METHODS:We searched CINAHL, EMBASE, MEDLINE and PsycINFO databases for studies that provided qualitative data on the psychosocial experiences of a diagnosis of GDM on women across any stage of pregnancy and/or the postpartum period. We appraised the methodological quality of the included studies using the Critical Appraisal Skills Programme Checklist for Qualitative Studies and used thematic analysis to synthesis the data. RESULTS:Of 840 studies identified, 41 studies of diverse populations met the selection criteria. The synthesis revealed eight key themes: initial psychological impact; communicating the diagnosis; knowledge of GDM; risk perception; management of GDM; burden of GDM; social support; and gaining control. The identified benefits of a GDM diagnosis were largely behavioural and included an opportunity to make healthy eating changes. The identified harms were emotional, financial and cultural. Women commented about the added responsibility (eating regimens, appointments), financial constraints (expensive food, medical bills) and conflicts with their cultural practices (alternative eating, lack of information about traditional food). Some women reported living in fear of risking the health of their baby and conducted extreme behaviours such as purging and starving themselves. CONCLUSION:A diagnosis of GDM has wide reaching consequences that are common to a diverse group of women. Threshold cut-offs for blood glucose levels have been determined using the risk of physiological harms to mother and baby. It may also be advantageous to consider the harms and benefits from a psychosocial and a physiological perspective. This may avoid unnecessary burden to an already vulnerable population.

Project description:BackgroundFor women with gestational diabetes mellitus (GDM) poor dietary choices can have deleterious consequences for both themselves and their baby. Diet is a well-recognised primary strategy for the management of GDM. Women who develop GDM may receive dietary recommendations from a range of sources that may be inconsistent and are often faced with needing to make several dietary adaptations in a short period of time to achieve glycaemic control. The aim of this study was to explore how women diagnosed with GDM perceive dietary recommendations and how this information influences their dietary decisions during pregnancy and beyond.MethodsWomen diagnosed with GDM before 30 weeks' gestation were purposively recruited from two GDM clinics in Auckland, New Zealand. Data were generated using semi-structured interviews and thematic analysed to identify themes describing women's perceptions and experiences of dietary recommendations for the management of GDM.ResultsEighteen women from a diverse range of sociodemographic backgrounds participated in the study. Three interconnected themes described women's perceptions of dietary recommendations and experiences in managing their GDM through diet: managing GDM is a balancing act; using the numbers as evidence, and the GDM timeframe. The primary objective of dietary advice was perceived to be to control blood glucose levels and this was central to each theme. Women faced a number of challenges in adhering to dietary recommendations. Their relationships with healthcare professionals played a significant role in their perception of advice and motivation to adhere to recommendations. Many women perceived the need to follow dietary recommendations to be temporary, with few planning to continue dietary adaptations long-term.ConclusionsThe value of empathetic, individually tailored advice was highlighted in this study. A greater emphasis on establishing healthy dietary habits not just during pregnancy but for the long-term health of both mother and baby is needed.

Project description:Latinos are the largest and fastest-growing minority group in the U.S., and Latina women represent the largest portion of minority births, having the highest birth rate in the U.S. for over 20 years. In addition, Latina women are at increased risk of entering pregnancy being overweight or having obesity and gaining excess gestational weight. Excess gestational weight gain (GWG) has short- and long-term adverse health outcomes for the woman and her child. Although culturally tailored interventions show promise toward promoting healthy GWG among Latina women, findings from current interventions have had mixed results, suggesting the need for further tailoring to meet the needs of this heterogeneous population group. This qualitative study was designed to explore first-time pregnant, low-income Latina women's beliefs, attitudes, and experiences with GWG. The study employed qualitative research using semi-structured interviews conducted with 23 first-time pregnant Latina women between 22 and 36 weeks of gestation. Interviews were conducted by trained bilingual staff, transcribed verbatim, and analyzed using thematic analysis. Results showed that participants were uncertain if their GWG was within a healthy range. Although the majority of participants knew that GWG should be limited, they were not sure what the amount should be. In addition, the majority of participants reported attitudes of acceptance of and resignation to excessive GWG as being part of pregnancy. Several women appeared to believe that they did not have control over their weight gain during pregnancy. Moreover, analysis identified that sociocultural and interpersonal factors such as social support influence the beliefs, attitudes, and experiences with GWG of the low-income, majority immigrant Latina women who participated in this study. Study findings can be used to further tailor prenatal care practices and interventions aimed at altering modifiable risk factors associated with excess GWG among Latinas. Future interventions designed for low-income, immigrant Latina women that consider sociocultural influences on women's beliefs and attitudes related to GWG, as well as the influence of social support networks on women's health behaviors during pregnancy, will likely be more effective in preventing excessive GWG.

Project description:BACKGROUND:Evidence has shown that there are several physical and mental advantages of exercise during pregnancy. Despite this, the recommendations for exercise during pregnancy are poorly fulfilled. The aim of this study was to illuminate non-exercising pregnant women's views and experiences concerning exercise before and during pregnancy. METHOD:The study had a qualitative design with an inductive approach and was analysed by content analysis. A total of 16 individual and face-to-face interviews were conducted with healthy pregnant women, mainly in the third trimester and living in Sweden. The participating women had not been exercising 3 months before pregnancy or during pregnancy. RESULTS:The main category "Insurmountable now, but possible in the future" was based on the four categories: "Lost and lack of routines", "Feelings of inadequacy", "Having a different focus" and "Need for support". The women experienced that their lack of routines was a major barrier that prevented them from exercising. Other factors that contributed were, for example, pregnancy-related problems, long working days and prioritizing family life. The women described it as difficult to combine exercise with their focus on the pregnancy and they missed continuous support from the antenatal care provider. The women expressed a need for suggestions concerning exercise during pregnancy and follow-up on previous counselling, especially when pregnancy-related issues arose. Information about easily accessible alternatives or simple home exercises was requested. They felt immobile and were not satisfied with their inactivity and tried to partly compensate with everyday activities. The women identified the postpartum period as an important possibility for becoming more active, for their own sake, but also because they wanted to become role models for their children. CONCLUSION:Continuous support during pregnancy is needed concerning exercise. Pregnancy is mostly a barrier that prevents exercise for this group of women but, at the same time, may be a motivator and a possibility for better health. As the result showed that these women were highly motivated to a life-style change post-pregnancy, it may be crucial to support previously non-exercising women postpartum.

Project description:BACKGROUND:Older Moroccan-Dutch migrant women exhibit high rates of diabetes, hypertension, overweight and obesity which is further compounded by their high risk of multi-morbidity. Healthcare professionals' efforts to encourage this group to adopt a healthier lifestyle have little success. We ask ourselves whether the concepts used in health education and promotion relate to these women's experiences and beliefs. Today's pluralistic Dutch society requires a more differentiated and applied approach, not in an essentialist way but in awareness that translation of rather individualized concepts like health and lifestyle is not always adequate, as the meaning and interpretation of such concepts may differ and may be related to women's other (fundamental) perceptions. This can have practical consequences for health promotion and education. The aim of this explorative, qualitative research, conducted between April and September 2015 and taking an intersectional approach, was to explore older Moroccan-Dutch women's perceptions of health and lifestyle and to analyse these in a broader context, related to other fundamental forms of identity such as gender, culture and religion. METHODS:We recruited women with Moroccan backgrounds by approaching Moroccan women's organisations and using the snowballing method (chain-referral sampling). Seven 'natural' group discussions were held (amongst women who regularly meet each other, aged between 22 and 69?years), and twelve in-depth interviews and an observation day (with women from 40 to 66?years). The transcripts were then analysed using thematic content analysis. RESULTS:Five major themes were identified. Health was perceived of in the terms used in prevailing health promotion discourses in the Netherlands, but lifestyle was interpreted in a much broader sense than the current health promotion debate allows; it is not seen as an individual responsibility or as something an individual could control on their own, and the social benefits of health behaviours appear to outweigh the health benefits themselves. Lifestyle was located in three main social identities of the women: Moroccan, Muslim and mother. Finally, Ramadan played a huge and dominant role in the lifestyle experience of older Moroccan women and was central in this research. CONCLUSIONS:The finding that lifestyle is not seen as an individual responsibility but is located in social identities, can be applied to other settings that older migrant-Dutch women occupy. Further research will clarify this.

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Preeclampsia, gestational diabetes and later risk of cardiovascular disease: Women's experiences and motivation for lifestyle changes explored in focus group interviews.

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Preeclampsia, gestational diabetes and later risk of cardiovascular disease: Women's experiences and motivation for lifestyle changes explored in focus group interviews.

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