Gestational Diabetes Mellitus (GDM) is defined as any degree of glucose intolerance which is recognised or first diagnosed in pregnancy. GDM is one of the most common medical complications observed in pregnancy.
The incidence of diabetes in pregnancy is increasing in Ireland and worldwide. The diagnosis of GDM increases maternal and foetal morbidity and is associated with an increased risk of future type 2 diabetes. Women diagnosed with GDM need to be empowered to manage this new unexpected and unwelcomed complication of pregnancy, at an otherwise joyful time.
Between 2011- 2015 we organised the facilitated diabetes midwife-led multi-disciplinary lifestyle group sessions in order to help women to gain confidence and knowledge of self-management GDM and have ownership of their diagnosis.
GDM is considered high risk hence we start management a.s.a.p. within 24-48 hrs by contacting the woman via our telehealth and internet service. Women are invited to attend a multidisciplinary lifestyle group session, followed by the regular reviews and assessment at the midwife led clinics for the duration of their pregnancy, delivery and postnatally for future advice.
Self-efficacy and self-management ability play a very important role in the management of diabetes. For the midwife specialised in diabetes care, and the multidisciplinary health-care teams it is significant to learn and be aware of the psycho-emotional state of the woman and help / facilitate her to gain confidence and increase self-efficacy and ability to manage GDM.
During the lifestyle group discussion sessions, the midwife used a self-reporting exercise and encouraged women to express their feelings, attitudes, concerns and reactions towards their diagnosis of GDM. We found that the diagnosis of GDM caused women substantial psycho-emotional reactions such as upset, worry, disappointment, fear, anxiety, annoyance, self-blame, sad, scared, shocked, and guilt. Diabetes distress causes psycho-emotional reactions and hinders the self-efficacy and self-care ability.
The findings of our qualitative study and another follow up study revealed women’s state of mind and responses towards their diagnosis. The follow up study found similar responses and indicated that with time, support, and information, initial feelings of anxiety, annoyance, and guilt evolved into a view of gestational diabetes as a manageable complication. These two studies indicate the important role of the multidisciplinary health-care teams, education, family, friends, and other women in the care of women with gestational diabetes. Importantly, themes emerging from the study also suggested that at least some participants realised the implications of a diagnosis of gestational diabetes for their future health.
It is possible to manage GDM with lifestyle changes. Midwives specialised in diabetes care in pregnancy play a very significant role in facilitating women to gain confidence in their self-efficacy and self-care ability. As holistic healthcare providers, midwives not only focus on insulin requirements and estimation of foetal weight but also appreciate the emotional impact of the diagnosis of gestational diabetes and how it can affect the care of our patients. Having an insight into women’s emotional reaction to a diagnosis of gestational diabetes can help all members of the clinical team to work with and care for women and their babies.
Audience Take Away:
- Importance of exploring and appreciating the women’s reaction to GDM,
- Role of Midwife specialist in the management of GDM especially psycho-emotional aspects to help women to gain confidence in their own self-efficacy and ability.
- Help women with GDM to achieve the goal of “ HEALTHY and POSITIVE OUTCOME of Pregnancy”
- Reviewing the diabetes lifestyle sessions
- Exploring psycho-emotional aspect of the diabetes care
- Knowledge of reaction towards diagnosis helps health care professional to deal with person’s diabetes distress
- Diabetes distress significantly affects the self-care ability hence this study could be used by the other settings or faculties in order to improve their care and management of people with diabetes
- The findings of this study indicate that not only medical management but how important and practical it is to help people with diabetes to gain confidence in their self-care.