Document Type : Original Article
Authors
Abstract
Introduction: Diabetes is increasingly becoming prevalent worldwide. Pregnancy with diabetes
is prone to maternal and fetal complications. Preconception care (PCC) is an important
factor in alleviating gestational complications in those women who suffer from diabetes. This
study seeks to gain insight into experiences of diabetic women and providers about PCC.
Subjects and Methods: The present research was a qualitative research conducted on eight
women with diabetes during the reproductive age and 15 health care providers of the public and
private medical centers, which provide health care for women with diabetes in Isfahan (Iran), with
a qualitative approach. Based on the aims of research, purposive sampling was done through
semi‑structuralized individual interview. Data were analyzed using conventional qualitative
content analysis method. Results: Data analysis revealed three major categories: (1) Health
centers weakness in providing PCC for diabetic women, (2) lack of a comprehensive PCC plan
for diabetic women and (3) diabetic women’s negligence about having planned pregnancy.
Conclusion: In order to improve diabetic women’s health, precise training of students, health
care providers and patients themselves with respect to PCCs should be taken into account.
Designing diabetic PCC system is an essential factor to succeed in this trend.
Keywords
1. Wolfson EM, DeKalb A, Rojhani A. Women’s health in the
21st century. Int J Gynaecol Obstet 2009;104:S2‑3.
2. Lawrence JM. Women with diabetes in pregnancy: Different
perceptions and expectations. Best Pract Res Clin Obstet Gynaecol
2011;25:15‑24.
3. Vargas R, Repke JT, Ural SH. Type 1 diabetes mellitus and
pregnancy. Rev Obstet Gynecol 2010;3:92‑100.
4. Alikhani S. A national profile of NCD risk factors in the I.R. Iran.
Selected results of the first survey of the Iranian NCD risk factor
surveillance system 2005, Ministry of Health and Medical Education.
Center for Disease Control. Iran. Available from: http://www.who.int/
chp/steps/IR_IranSTEPSReport.pdf [Date of access: 13 Jan 2015].
5. Temple R, Murphy H. Type 2 diabetes in pregnancy‑An increasing
problem. Best Pract Res Clin Endocrinol Metab 2010;24:591‑603.
6. Roglic G. Diabetes in women: The global perspective. Int J Gynaecol
Obstet 2009;104 Suppl 1:S11‑3.
7. Sabaratnam A. Diabetes in pregnancy. Best Pract Res Clin Obstet
2011;25:1.
8. Damti A, Riskin‑Mashiah S. Preconception care and counseling
for women with diabetes and those at risk for diabetes. Harefuah
2009;148:447‑51, 475.
9. Inkster ME, Fahey TP, Donnan PT, Leese GP, Mires GJ, Murphy DJ.
The role of modifiable pre‑pregnancy risk factors in preventing
adverse fetal outcomes among women with type 1 and type 2
diabetes. Acta Obstet Gynecol Scand 2009;88:1153‑7.
10. Melamed N, Chen R, Soiberman U, Ben‑Haroush A, Hod M, Yogev Y.
Spontaneous and indicated preterm delivery in pregestational
diabetes mellitus: Etiology and risk factors. Arch Gynecol Obstet
2008;278:129‑34.
11. Hawdon JM. Babies born after diabetes in pregnancy: What are the
short‑ and long‑term risks and how can we minimise them? Best
Pract Res Clin Obstet Gynaecol 2011;25:91‑104.
12. Melamed N, Hod M. Perinatal mortality in pregestational diabetes.
Int J Gynaecol Obstet 2009;104 Suppl 1:S20‑4.
13. Tieu J, Middleton P, Crowther CA. Preconception care for diabetic
women for improving maternal and infant health. Cochrane
Database Syst Rev 2010 8 (12):CD007776.
14. Wender‑Ozegowska E, Gutaj P, Szczepanek U, Ozegowska K,
Zawiejska A, Brazert J. Influence of pregnancy planning on
obstetrical results in women with pregestational diabetes mellitus.
Ginekol Pol 2010;81:762‑7.
15. Temple R. Preconception care for women with diabetes: Is it effective and who should provide it? Best Pract Res Clin Obstet
Gynaecol 2011;25:3‑14.
16. Wahabi HA, Alzeidan RA, Bawazeer GA, Alansari LA, Esmaeil SA.
Preconception care for diabetic women for improving maternal
and fetal outcomes: A systematic review and meta‑analysis. BMC
Pregnancy Childbirth 2010;10:63.
17. Tripathi A, Rankin J, Aarvold J, Chandler C, Bell R. Preconception
counseling in women with diabetes: A population‑based study in
the north of England. Diabetes Care 2010;33:586‑8.
18. Bernasko J. Contemporary management of type 1 diabetes mellitus
in pregnancy. Obstet Gynecol Surv 2004;59:628‑36.
19. Kitzmiller JL, Wallerstein R, Correa A, Kwan S. Preconception
care for women with diabetes and prevention of major congenital
malformations. Birth Defects Res A Clin Mol Teratol 2010;88:791‑803.
20. Mahmud M, Mazza D. Preconception care of women with diabetes:
A review of current guideline recommendations. BMC Womens
Health 2010;10:5.
21. Murphy HR, Roland JM, Skinner TC. Effectiveness of a regional
prepregnancy care program in women with type 1 and type 2
diabetes: Benefits beyond glycemic control. Obstet Gynecol Surv
2011;66:189‑91.
22. Negrato CA, Mattar R, Gomes MB. Adverse pregnancy outcomes
in women with diabetes. Diabetol Metab Syndr 2012;4:41.
23. van Heesch PN, de Weerd S, Kotey S, Steegers EA. Dutch
community midwives’ views on preconception care. Midwifery
2006;22:120‑4.
24. Packguhar M, Nekui N, Khakbazan Z, Mahmud M. The midwifery
students’ knowledge and clinical decision making skills about
preconception care. Iran J Nurs Midwifery Res 2008;13:65‑71.
25. Michel B, Charron‑Prochownik D. Diabetes nurse educators and
preconception counseling. Diabetes Educ 2006;32:108‑16.
26. Kitamura K, Fetters MD, Ban N. Preconception care by family
physicians and general practitioners in Japan. BMC Fam Pract
2005;6:31.
27. Cothran MM, Sereika SM, Fischl AR, Schmitt PL,
Charron‑Prochownik D. A self‑instructional program for diabetes
educators on preconception counseling for women with diabetes.
Diabetes Educ 2009;35:652‑6.
28. MakkiAwouda FO, Elmukashfi TA, Hag Al‑Tom SA. Designing an
educational and training program for diabetes health educators at
Diabetic Health Centers, Khartoum State, Sudan; 2007‑2010. Glob
J Health Sci 2013;5:207‑11.
29. Kapoor N, Sankaran S, Hyer S, Shehata H. Diabetes in pregnancy:
A review of current evidence. Curr Opin Obstet Gynecol
2007;19:586‑90.
30. Pridjian G. Pregestational diabetes. Obstet Gynecol Clin North Am
2010;37:143‑58.
31. Schwarz EB, Santucci A, Borrero S, Akers AY, Nikolajski C,
Gold MA. Perspectives of primary care clinicians on teratogenic risk
counseling. Birth Defects Res A Clin Mol Teratol 2009;85:858‑63.
32. Hone J, Jovanovic L. Approach to the patient with diabetes during
pregnancy. J Clin Endocrinol Metab 2010;95:3578‑85.
33. PollardC, Bailey KA, Petitte T, Baus A, Swim M, Hendryx M. Electronic
patient registries improve diabetes care and clinical outcomes in rural
community health centers. J Rural Health 2009;25:77‑84.
34. Shawe J, Smith P, Stephenson J. Use of contraception by women
with type 1 or type 2 diabetes mellitus: ‘it’s funny that nobody
really spoke to me about it’. Eur J Contracept Reprod Health Care
2011;16:350‑8.
35. Rodríguez‑Vigil E, Kianes‑Pérez Z. Quality of care provided to
patients with diabetes mellitus in Puerto Rico; managed care versus
fee‑for‑service experience. Endocr Pract 2005;11:376‑81.
36. Murphy HR, Temple RC, Ball VE, Roland JM, Steel S, Zill‑E‑Huma R,
et al. Personal experiences of women with diabetes who do not
attend pre‑pregnancy care. Diabet Med 2010;27:92‑100.
37. Mersereau P, Williams J, Collier SA, Mulholland C, Turay K, Prue C.
Barriers to managing diabetes during pregnancy: The perceptions
of health care practitioners. Birth 2011;38:142‑9.
38. Diabetes and Pregnancy Group. Knowledge about preconception
care in French women with type 1 diabetes. Diabetes Metab
2005;31:443‑7.
39. Shen H, Edwards H, Courtney M, McDowell J, Wei J. Barriers and
facilitators to diabetes self‑management: Perspectives of older
community dwellers and health professionals in China. Int J Nurs
Pract 2013;19:627‑35.
40. Shiau SJ, Cheng LS, Gau BS, Tsai LM, Lin BJ. The effects of
management difficulty and family functions on metabolic control
of insulin‑dependent diabetes mellitus. Gaoxiong Yi Xue Ke Xue
Za Zhi 1995;11:157‑63.
41. Li J, Drury V, Taylor B. ‘Diabetes is nothing’: The experience of
older Singaporean women living and coping with type 2 diabetes.
Contemp Nurse 2013;45:188‑96.
42. Chuang CH, Velott DL, Weisman CS. Exploring knowledge and
attitudes related to pregnancy and preconception health in women
with chronic medical conditions. Matern Child Health J 2010;14:713‑9.
43. Charron‑Prochownik D, Sereika SM, Falsetti D, Wang SL, Becker D,
Jacober S, et al. Knowledge, attitudes and behaviors related to
sexuality and family planning in adolescent women with and without
diabetes. Pediatr Diabetes 2006;7:267‑73.
21st century. Int J Gynaecol Obstet 2009;104:S2‑3.
2. Lawrence JM. Women with diabetes in pregnancy: Different
perceptions and expectations. Best Pract Res Clin Obstet Gynaecol
2011;25:15‑24.
3. Vargas R, Repke JT, Ural SH. Type 1 diabetes mellitus and
pregnancy. Rev Obstet Gynecol 2010;3:92‑100.
4. Alikhani S. A national profile of NCD risk factors in the I.R. Iran.
Selected results of the first survey of the Iranian NCD risk factor
surveillance system 2005, Ministry of Health and Medical Education.
Center for Disease Control. Iran. Available from: http://www.who.int/
chp/steps/IR_IranSTEPSReport.pdf [Date of access: 13 Jan 2015].
5. Temple R, Murphy H. Type 2 diabetes in pregnancy‑An increasing
problem. Best Pract Res Clin Endocrinol Metab 2010;24:591‑603.
6. Roglic G. Diabetes in women: The global perspective. Int J Gynaecol
Obstet 2009;104 Suppl 1:S11‑3.
7. Sabaratnam A. Diabetes in pregnancy. Best Pract Res Clin Obstet
2011;25:1.
8. Damti A, Riskin‑Mashiah S. Preconception care and counseling
for women with diabetes and those at risk for diabetes. Harefuah
2009;148:447‑51, 475.
9. Inkster ME, Fahey TP, Donnan PT, Leese GP, Mires GJ, Murphy DJ.
The role of modifiable pre‑pregnancy risk factors in preventing
adverse fetal outcomes among women with type 1 and type 2
diabetes. Acta Obstet Gynecol Scand 2009;88:1153‑7.
10. Melamed N, Chen R, Soiberman U, Ben‑Haroush A, Hod M, Yogev Y.
Spontaneous and indicated preterm delivery in pregestational
diabetes mellitus: Etiology and risk factors. Arch Gynecol Obstet
2008;278:129‑34.
11. Hawdon JM. Babies born after diabetes in pregnancy: What are the
short‑ and long‑term risks and how can we minimise them? Best
Pract Res Clin Obstet Gynaecol 2011;25:91‑104.
12. Melamed N, Hod M. Perinatal mortality in pregestational diabetes.
Int J Gynaecol Obstet 2009;104 Suppl 1:S20‑4.
13. Tieu J, Middleton P, Crowther CA. Preconception care for diabetic
women for improving maternal and infant health. Cochrane
Database Syst Rev 2010 8 (12):CD007776.
14. Wender‑Ozegowska E, Gutaj P, Szczepanek U, Ozegowska K,
Zawiejska A, Brazert J. Influence of pregnancy planning on
obstetrical results in women with pregestational diabetes mellitus.
Ginekol Pol 2010;81:762‑7.
15. Temple R. Preconception care for women with diabetes: Is it effective and who should provide it? Best Pract Res Clin Obstet
Gynaecol 2011;25:3‑14.
16. Wahabi HA, Alzeidan RA, Bawazeer GA, Alansari LA, Esmaeil SA.
Preconception care for diabetic women for improving maternal
and fetal outcomes: A systematic review and meta‑analysis. BMC
Pregnancy Childbirth 2010;10:63.
17. Tripathi A, Rankin J, Aarvold J, Chandler C, Bell R. Preconception
counseling in women with diabetes: A population‑based study in
the north of England. Diabetes Care 2010;33:586‑8.
18. Bernasko J. Contemporary management of type 1 diabetes mellitus
in pregnancy. Obstet Gynecol Surv 2004;59:628‑36.
19. Kitzmiller JL, Wallerstein R, Correa A, Kwan S. Preconception
care for women with diabetes and prevention of major congenital
malformations. Birth Defects Res A Clin Mol Teratol 2010;88:791‑803.
20. Mahmud M, Mazza D. Preconception care of women with diabetes:
A review of current guideline recommendations. BMC Womens
Health 2010;10:5.
21. Murphy HR, Roland JM, Skinner TC. Effectiveness of a regional
prepregnancy care program in women with type 1 and type 2
diabetes: Benefits beyond glycemic control. Obstet Gynecol Surv
2011;66:189‑91.
22. Negrato CA, Mattar R, Gomes MB. Adverse pregnancy outcomes
in women with diabetes. Diabetol Metab Syndr 2012;4:41.
23. van Heesch PN, de Weerd S, Kotey S, Steegers EA. Dutch
community midwives’ views on preconception care. Midwifery
2006;22:120‑4.
24. Packguhar M, Nekui N, Khakbazan Z, Mahmud M. The midwifery
students’ knowledge and clinical decision making skills about
preconception care. Iran J Nurs Midwifery Res 2008;13:65‑71.
25. Michel B, Charron‑Prochownik D. Diabetes nurse educators and
preconception counseling. Diabetes Educ 2006;32:108‑16.
26. Kitamura K, Fetters MD, Ban N. Preconception care by family
physicians and general practitioners in Japan. BMC Fam Pract
2005;6:31.
27. Cothran MM, Sereika SM, Fischl AR, Schmitt PL,
Charron‑Prochownik D. A self‑instructional program for diabetes
educators on preconception counseling for women with diabetes.
Diabetes Educ 2009;35:652‑6.
28. MakkiAwouda FO, Elmukashfi TA, Hag Al‑Tom SA. Designing an
educational and training program for diabetes health educators at
Diabetic Health Centers, Khartoum State, Sudan; 2007‑2010. Glob
J Health Sci 2013;5:207‑11.
29. Kapoor N, Sankaran S, Hyer S, Shehata H. Diabetes in pregnancy:
A review of current evidence. Curr Opin Obstet Gynecol
2007;19:586‑90.
30. Pridjian G. Pregestational diabetes. Obstet Gynecol Clin North Am
2010;37:143‑58.
31. Schwarz EB, Santucci A, Borrero S, Akers AY, Nikolajski C,
Gold MA. Perspectives of primary care clinicians on teratogenic risk
counseling. Birth Defects Res A Clin Mol Teratol 2009;85:858‑63.
32. Hone J, Jovanovic L. Approach to the patient with diabetes during
pregnancy. J Clin Endocrinol Metab 2010;95:3578‑85.
33. PollardC, Bailey KA, Petitte T, Baus A, Swim M, Hendryx M. Electronic
patient registries improve diabetes care and clinical outcomes in rural
community health centers. J Rural Health 2009;25:77‑84.
34. Shawe J, Smith P, Stephenson J. Use of contraception by women
with type 1 or type 2 diabetes mellitus: ‘it’s funny that nobody
really spoke to me about it’. Eur J Contracept Reprod Health Care
2011;16:350‑8.
35. Rodríguez‑Vigil E, Kianes‑Pérez Z. Quality of care provided to
patients with diabetes mellitus in Puerto Rico; managed care versus
fee‑for‑service experience. Endocr Pract 2005;11:376‑81.
36. Murphy HR, Temple RC, Ball VE, Roland JM, Steel S, Zill‑E‑Huma R,
et al. Personal experiences of women with diabetes who do not
attend pre‑pregnancy care. Diabet Med 2010;27:92‑100.
37. Mersereau P, Williams J, Collier SA, Mulholland C, Turay K, Prue C.
Barriers to managing diabetes during pregnancy: The perceptions
of health care practitioners. Birth 2011;38:142‑9.
38. Diabetes and Pregnancy Group. Knowledge about preconception
care in French women with type 1 diabetes. Diabetes Metab
2005;31:443‑7.
39. Shen H, Edwards H, Courtney M, McDowell J, Wei J. Barriers and
facilitators to diabetes self‑management: Perspectives of older
community dwellers and health professionals in China. Int J Nurs
Pract 2013;19:627‑35.
40. Shiau SJ, Cheng LS, Gau BS, Tsai LM, Lin BJ. The effects of
management difficulty and family functions on metabolic control
of insulin‑dependent diabetes mellitus. Gaoxiong Yi Xue Ke Xue
Za Zhi 1995;11:157‑63.
41. Li J, Drury V, Taylor B. ‘Diabetes is nothing’: The experience of
older Singaporean women living and coping with type 2 diabetes.
Contemp Nurse 2013;45:188‑96.
42. Chuang CH, Velott DL, Weisman CS. Exploring knowledge and
attitudes related to pregnancy and preconception health in women
with chronic medical conditions. Matern Child Health J 2010;14:713‑9.
43. Charron‑Prochownik D, Sereika SM, Falsetti D, Wang SL, Becker D,
Jacober S, et al. Knowledge, attitudes and behaviors related to
sexuality and family planning in adolescent women with and without
diabetes. Pediatr Diabetes 2006;7:267‑73.
)