Gestational Diabetes Nursing Case Study

Gestational Diabetes Nursing Case Study-19
We identified seven themes: the disrupted pregnancy, projected anxiety, reproductive asceticism, women as baby machines, perceived stigma, lack of shared understanding and postpartum abandonment.These themes highlight the often distressing experience of GDM.

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Gestational diabetes mellitus (GDM) affects up to 5% of all pregnancies in the UK [1], between 1% and 25% of pregnancies globally, [2] and its incidence is increasing [3].

GDM is associated with an increased risk of adverse fetal, infant and maternal pregnancy outcomes including preeclampsia, primary caesarean section, excessive fetal growth (large for gestational age or macrosomia), shoulder dystocia or birth injury, neonatal hypoglycaemia, and admission to neonatal intensive care [4].

The unit currently sees around 200 women with GDM per year and has good biomedical pregnancy outcomes, with rates of macrosomia and preeclampsia lower than in the intervention arm of the ACHOIS trial [9] (a large study exploring whether treatment of GDM would reduce perinatal complications) and similar low rates of shoulder dystocia and emergency Caesarean section.

To achieve these outcomes the women are intensively managed by a multidisciplinary team of diabetes specialist nurses, doctors, dietitians, obstetricians and specialist midwives with weekly or fortnightly clinic visits.

The risk of adverse pregnancy outcomes can be improved by interventions directed at reducing blood glucose during pregnancy.

These include self-monitoring of blood glucose, lifestyle changes and the use of glucose lowering therapies such as metformin and insulin [9,10,11].While the high blood glucose of GDM usually resolves after delivery, women with GDM have an increased risk of further episodes of GDM [5] and are seven times more likely to develop type 2 diabetes mellitus (T2DM) [6] than women with normoglycaemic pregnancies.In addition, there is growing evidence that hyperglycaemia in pregnancy has a programming effect on the long-term metabolic health of the offspring, increasing their risk of T2DM [7, 8].While most women were grateful for the intensive support they received during pregnancy, the costs to their personal autonomy were high.Women described feeling valued solely as a means to produce a healthy infant, and felt chastised if they failed to adhere to the behaviours required to achieve this.In order to cater for different preferences and to widen our participation we offered participants the choice of either a focus group or an interview, and whether the interview took place on the phone, in a non-clinical building on the hospital site, or at the participant’s home.The study was conducted in a diabetes pregnancy unit at a large teaching hospital in London, UK.Framework analysis was used to support an integrated analysis of data from six focus groups with 35 women and semi-structured interviews with 15 women, held in 2015.Participants were purposively sampled and were representative of the population being studied in terms of ethnicity, age, deprivation score and body mass index (BMI).Healthcare delivery may need to be reoriented to improve the pregnancy experience and help ensure women are engaged and attentive to their own health, particularly after birth, without compromising clinical pregnancy outcomes.Areas for consideration in GDM healthcare include: improved management of emotional responses to GDM; a more motivational approach; rethinking the medicalisation of care; and improved postpartum care.


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