Supporting the Journey of Pregnancy for Women with Type 1 Diabetes
Diabetes is one of the most common medical conditions complicating pregnancy. Despite improvements in care, management of pregnancy for women with type 1 diabetes remains challenging. Adverse outcomes include congenital anomalies, stillbirth and perinatal mortality. There is well established evidence that the risks can be significantly reduced by attendance at pre-pregnancy counselling. However, for a variety of reasons, uptake is persistently low. Contemplation of pregnancy is an opportune time to offer information about pre-pregnancy counselling. This time-phase of the pregnancy journey may last many years, and precedes pregnancy planning. Women with type 1 diabetes might be seeking knowledge, reassurance, and a sense of optimism about pregnancy from their peers, via internet-based resources, before and/or instead of, approaching a health care professional. Along with peer support, internet-based pregnancy resources can offer balanced information about the risks of pregnancy, coupled with positive stories about becoming and being a mother with type 1 diabetes. Women with type 1 diabetes may expect more intensive medical intervention during pregnancy and can experience reassurance from this, however the intense focus on diabetes management can detract from the experience of pregnancy itself. There can be mental health impacts and increased experiences of diabetes specific distress, that might be different to other times of their lives. Communication about pregnancy needs to be balanced and timely. Supporting the Journey of Pregnancy for Women with type 1 diabetes 11 More information is needed for both women with type 1 diabetes and health care professionals, about what pre-pregnancy counselling involves, where it is available and why it is important. There should be a person-centred approach. This Thesis firstly explores the pregnancy journey for women with type 1 diabetes through a thematic analysis of online diabetes counselling records. This results in the development of a theoretically driven model of the pregnancy journey, which highlights the time-phases, from Contemplation to Motherhood. Focusing on the Contemplation phase, I then develop a prototype Contemplating Pregnancy in Diabetes Communication Support Questionnaire, to enhance this journey. The aim is to open up conversation about preparedness for pregnancy, rather than to assess or affect, outcomes. This is now ready for further testing. Finally, I present a meta-synthesis of the current themes in the qualitative literature around using internet-based programmes and resources to offer women with type 1 diabetes pregnancy information and support. I conclude that in order to reduce the risks of adverse outcomes, pregnancy information, and in particular the importance of pre-pregnancy counselling, needs to be freely available across the child-bearing years. Discussions about pregnancy planning should occur earlier and more often. I recommend discussions about preparedness for pregnancy should include both the desirable health related behaviours for a healthy pregnancy and an understanding of the personal, social and psychological resources available for the journey. I suggest that to encourage positive pregnancy conversations between health care professionals and women with type 1 diabetes and allow women to drive their seeking of pregnancy information, more internet-based pregnancy and diabetes resources must be developed and evaluated. Women with type 1 diabetes should be included in the development and delivery of these.
type 1 diabetes, diabetes, diabetes and pregnancy, diabetes psychology
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