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A qualitative study of perceived barriers to management of diabetes among women with a history of diabetes during pregnancy.

BACKGROUND
Uncontrolled diabetes during pregnancy can cause adverse maternal and infant outcomes. This study explored barriers to glycemic control before, during, and after pregnancy and describes knowledge, attitudes, and behaviors among pregnant women with pregestational diabetes (PGDM) or gestational diabetes (GDM).


METHODS
Focus groups were conducted in the Atlanta area among white, black, and Hispanic women who had diabetes during a recent pregnancy. Participants were a convenience sample drawn from a variety of sources. Nine focus groups were held with women who had GDM, and seven focus groups were held with women who had PGDM.


RESULTS
Participants identified five main areas of barriers to management of diabetes during pregnancy: financial barriers and difficulties accessing care, barriers to maintaining a healthy diet and exercising, communication difficulties, lack of social support, and barriers related to diabetes care. Participants with GDM had general awareness of possible diabetes complications but frequently could not name specific effects of diabetes on the woman or child during and after pregnancy. Most were unaware of their risk for developing type 2 diabetes later. Participants with PGDM expressed concern about the increased risk of adverse outcomes for the baby; most knew the importance of maintaining glycemic control during pregnancy. Low rates of pregnancy planning were reported in both groups. Pregnancy planning was not identified as a strategy to ensure a healthy baby.


CONCLUSIONS
The barriers to achieving glycemic control during pregnancy identified in this study could help inform future efforts to assist women in achieving optimal prepregnancy and intrapregnancy glycemic control.