A Qualitative Study: Mothers’ Experience in the Management of Gestational Diabetes Mellitus during and after Pregnancy in Yogyakarta, Indonesia

Claudia Banowati Subarto; Mika Matsuzaki; Michelle Estrade; Samantha Sundemeir; Mohammad Hakimi; Yuli Isnaeni; Hamam Hadi; Yulinda Kurniasari; Siti Fatimah; Linda  Yulyani; Indah Wijayanti

doi:10.3889/oamjms.2022.9500

Authors

Claudia Banowati Subarto Department of Midwifery, Faculty of Health Sciences, Alma Ata University, Yogyakarta, Indonesia; Department of Midwifery, Faculty of Health Sciences, Universitas ‘Aisyiyah, Yogyakarta, Indonesia https://orcid.org/0000-0002-1475-6859
Mika Matsuzaki Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States https://orcid.org/0000-0002-7020-3757
Michelle Estrade Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States https://orcid.org/0000-0002-3972-3471
Samantha Sundemeir Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
Mohammad Hakimi Department of Obstetrics and Gynecology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
Yuli Isnaeni Department of Community Nursing, Universitas ‘Aisyiyah, Yogyakarta, Indonesia
Hamam Hadi Department of Nutrition, Faculty of Health Sciences, Alma Ata University, Yogyakarta, Indonesia
Yulinda Kurniasari Department of Nutrition, Faculty of Health Sciences, Alma Ata University, Yogyakarta, Indonesia
Siti Fatimah Department of Nutrition, Faculty of Health Sciences, Alma Ata University, Yogyakarta, Indonesia https://orcid.org/0000-0002-1160-3929
Linda Yulyani Department of Midwifery, Faculty of Health Sciences, Alma Ata University, Yogyakarta, Indonesia https://orcid.org/0000-0001-6921-753X
Indah Wijayanti Department of Midwifery, Faculty of Health Sciences, Alma Ata University, Yogyakarta, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2022.9500

Keywords:

Gestational Diabetes, Pregnancy, Post-Partum, Social Support, Qualitative Research

Abstract

Background: Gestational Diabetes Mellitus (GDM) incidence is related to maternal and child health risks, such as pre-eclampsia, premature births, and the development of type 2 diabetes at 5-10 years after pregnancy. The adaptation process of women with GDM is complicated and requires a series of treatments and behavior changes over a short period. The psychological support of families and healthcare professionals is indispensable in achieving GDM management success.

Objectives: This research aimed to explore Indonesian mothers' experiences in GDM management and support during and after pregnancy

Methods: The design of research implemented qualitative approaches, phenomenology, and the homogenous purposive technique to recruit 12 participants. In-depth interviews were carried out with each participant using face to face. Interviews were recorded, verbatim transcribed, and analyzed thematically by Collaizi.

Results: Five themes emerged: responses to GDM diagnosis; GDM management during pregnancy; obstacles in GDM management; support for GDM management; and post-natal self-management. Adherence to diet and exercise recommendations is difficult for some participants, although they have a good understanding of GDM. Feeling the fetus's movement of and surrendering to God become forms of psychological support and motivation in the management of gestational diabetes mellitus.

Conclusions: The barriers and facilitators for GDM management identified here are multidimensional and may help facilitate health workers to more effectively support women with GDM in overcoming the perceived obstacles so that they can still feel a safe and comfortable during pregnancy with minimum risk.

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References

ACOG practice bulletin No. 202: Gestational hypertension and preeclampsia. Obstet Gynecol. 2019;133:e1. https://doi.org/10.1097/AOG.0000000000003018 PMid:30575675 DOI: https://doi.org/10.1097/AOG.0000000000003018

Behboudi-Gandevani S, Amiri M, Yarandi RB, Tehrani FR. The impact of diagnostic criteria for gestational diabetes on its prevalence: A systematic review and meta-analysis. Diabetol Metab Syndr 2019;11:11. https://doi.org/10.1186/s13098-019-0406-1 PMid:30733833 DOI: https://doi.org/10.1186/s13098-019-0406-1

Han S, Middleton PF, Bubner TK, Crowther CA. Women’s views on their diagnosis and management for borderline gestational diabetes mellitus. J Diabetes Res. 2015;2015:209215. https://doi.org/10.1155/2015/209215 PMid:25785278 DOI: https://doi.org/10.1155/2015/209215

Purnamasari D, Waspadji S, Adam JM, Rudijanto A, Tahapary D. Indonesian clinical practice guidelines for diabetes in pregnancy. J ASEAN Fed Endocr Soc. 2014;28:9. DOI: https://doi.org/10.15605/jafes.028.01.02

Lee KW, Ching SM, Ramachandran V, Yee A, Hoo FK, Chia YC, et al. Prevalence and risk factors of gestational diabetes mellitus in Asia: A systematic review and meta-analysis. BMC Pregnancy Childbirth. 2018;18(1):494. https://doi.org/10.1186/s12884-018-2131-4 PMid:30547769 DOI: https://doi.org/10.1186/s12884-018-2131-4

Zhu Y, Zhang C. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: A global perspective. Curr Diab Rep. 2016;16(1):7. https://doi.org/10.1007/s11892-015-0699-x PMid:26742932 DOI: https://doi.org/10.1007/s11892-015-0699-x

Kampmann U, Madsen LR, Skajaa GO, Iversen DS, Moeller N, Ovesen P. Gestational diabetes: A clinical update. World J Diabetes. 2015;6(8):1065-72. https://doi.org/10.4239/wjd.v6.i8.1065 PMid:26240703 DOI: https://doi.org/10.4239/wjd.v6.i8.1065

Alfadhli EM. Gestational diabetes mellitus. Saudi Med J. 2015;36:399-406. DOI: https://doi.org/10.15537/smj.2015.4.10307

ACOG practice bulletin no. 190: Gestational diabetes mellitus. Obstet Gynecol. 2018;131:e49-64. https://doi.org/10.1097/AOG.0000000000002501 PMid:29370047 DOI: https://doi.org/10.1097/AOG.0000000000002501

Khooshehchin TE, Keshavarz Z, Afrakhteh M, Shakibazadeh E, Faghihzadeh S. Perceived needs in women with gestational diabetes: A qualitative study. Electron Phys. 2016;8(12):3412-20. https://doi.org/10.19082/3412 PMid:28163857 DOI: https://doi.org/10.19082/3412

Parsons J, Ismail K, Amiel S, Forbes A. Perceptions among women with gestational diabetes. Qual Health Res. 2014;24:575-85. https://doi.org/10.1177/1049732314524636 PMid:24682021 DOI: https://doi.org/10.1177/1049732314524636

Vounzoulaki E, Khunti K, Abner SC, Tan BK, Davies MJ, Gillies CL. Progression to type 2 diabetes in women with a known history of gestational diabetes: Systematic review and meta-analysis. BMJ. 2020;369:m1361. DOI: https://doi.org/10.1136/bmj.m1361

Li JW, He SY, Liu P, Luo L, Zhao L, Xiao YB. Association of gestational diabetes mellitus (GDM) with subclinical atherosclerosis: A systemic review and meta-analysis. BMC Cardiovasc Disord. 2014;14:132. https://doi.org/10.1186/1471-2261-14-132 PMid:25266849 DOI: https://doi.org/10.1186/1471-2261-14-132

Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH. The pathophysiology of gestational diabetes mellitus. Int J Mol Sci. 2018;19(11):3342. https://doi.org/10.3390/ijms19113342 PMid:30373146 DOI: https://doi.org/10.3390/ijms19113342

Basri NI, Mahdy ZA, Ahmad S, Abdul Karim AK, Shan LP, Abdul Manaf MR, et al. The World Health Organization (WHO) versus The International Association of Diabetes and Pregnancy Study Group (IADPSG) diagnostic criteria of gestational diabetes mellitus (GDM) and their associated maternal and neonatal outcomes. Horm Mol Biol Clin Investig. 2018;34(1):77. https://doi.org/10.1515/hmbci-2017-0077 PMid:29453924 DOI: https://doi.org/10.1515/hmbci-2017-0077

Gascho CL, Leandro DM, Silva T, Silva JC. Predictors of cesarean delivery in pregnant women with gestational diabetes mellitus. Rev Bras Ginecol E Obstet Rev Fed Bras Soc Ginecol E Obstet. 2017;39:60-5. https://doi.org/10.1055/s-0037-1598644 PMid:28231597 DOI: https://doi.org/10.1055/s-0037-1598644

Parsons J, Sparrow K, Ismail K, Hunt K, Rogers H, Forbes A. Experiences of gestational diabetes and gestational diabetes care: A focus group and interview study. BMC Pregnancy Childbirth. 2018;18(1):25. https://doi.org/10.1186/s12884-018-1657-9 PMid:29325518 DOI: https://doi.org/10.1186/s12884-018-1657-9

Jovanovic-Peterson L, Peterson CM, Reed GF, Metzger BE, Mills JL, Knopp RH, et al. Maternal postprandial glucose levels and infant birth weight: The diabetes in early pregnancy study. The national institute of child health and human development--diabetes in early pregnancy study. Am J Obstet Gynecol. 1991;164:103-11. https://doi.org/10.1016/0002-9378(91)90637-7 PMid:1986596 DOI: https://doi.org/10.1016/0002-9378(91)90637-7

Tong TY, Imamura F, Monsivais P, Brage S, Griffin SJ, Wareham NJ, et al. Dietary cost associated with adherence to the Mediterranean diet, and its variation by socio-economic factors in the UK Fenland study. Br J Nutr. 2018;119:685-94. https://doi.org/10.1017/S0007114517003993 PMid:29553031 DOI: https://doi.org/10.1017/S0007114517003993

Meal Planning, ADA. Available from: https://www.diabetes.org/healthy-living/recipes-nutrition/meal-planning [Last accessed on 2022 Mar 03].

Brown J, Alwan NA, West J, Brown S, McKinlay CJ, Farrar D, et al. Lifestyle interventions for the treatment of women with gestational diabetes. Cochrane Database Syst Rev. 2017;5(5):CD011970. https://doi.org/10.1002/14651858.CD011970.pub2 PMid:28472859 DOI: https://doi.org/10.1002/14651858.CD011970.pub2

Hidayati AN, Hadi H, Astiti D. Relationship between physical activity and hyperglycemia in kyai and teachers in Islamic boarding school in Yogyakarta. J Gizi Dan Diet Indones. 2018;5(3):98. DOI: https://doi.org/10.21927/ijnd.2017.5(3).98-105

Katsukawa F. FITT principle of exercise in the management of lifestyle-related diseases. Clin Calcium. 2016;26:447-51. PMid:26923984

Bianchi C, Battini L, Aragona M, Lencioni C, Ottanelli S, Romano M, et al. Prescribing exercise for prevention and treatment of gestational diabetes: Review of suggested recommendations. Gynecol Endocrinol. 2017;33:254-60. https://doi.org/10.1080/09513590.2016.1266474 PMid:28084847 DOI: https://doi.org/10.1080/09513590.2016.1266474

Rosyida RW, Putra MG, Rofiyati W, Yuli TI. The predictors of self empowerment on type 2 diabetes mellitus among Indonesian. Indones J Nurs Midwifery. 2020;8:11.

Astuti S, Paratmanitya Y, Wahyuningsih W. The level of knowledge and family support is not related to the type of compliance with diet therapy for people with diabetes mellitus 2 at the Primary Health Care II, Bantul, Yogyakarta. J Gizi Dan Diet Indones. 2016;3:105. DOI: https://doi.org/10.21927/ijnd.2015.3(2).105-112

Hayashi A, Oguchi H, Kozawa Y, Ban Y, Shinoda J, Suganuma N. Daily walking is effective for the management of pregnant women with gestational diabetes mellitus. J Obstet Gynaecol Res. 2018;44:1731-8. https://doi.org/10.1111/jog.13698 PMid:29974564 DOI: https://doi.org/10.1111/jog.13698

Egan AM, Dennedy MC, Al-Ramli W, Heerey A, Avalos G, Dunne F. ATLANTIC-DIP: Excessive gestational weight gain and pregnancy outcomes in women with gestational or pregestational diabetes mellitus. J Clin Endocrinol Metab. 2014;99(1):212-9. https://doi.org/10.1210/jc.2013-2684 PMid:24187402 DOI: https://doi.org/10.1210/jc.2013-2684

Hyer S, Balani J, Shehata H. Metformin in pregnancy: Mechanisms and clinical applications. Int J Mol Sci. 2018;19(7):1954. https://doi.org/10.3390/ijms19071954 PMid:29973490 DOI: https://doi.org/10.3390/ijms19071954

Patti AM, Giglio RV, Pafili K, Rizzo M, Papanas N. Pharmacotherapy for gestational diabetes. Expert Opin Pharmacother. 2018;19(13):1407-14. https://doi.org/10.1080/14656566.2018.1509955 PMid:30136869 DOI: https://doi.org/10.1080/14656566.2018.1509955

Gilbert L, Gross J, Lanzi S, Quansah DY, Puder J, Horsch A. How diet, physical activity and psychosocial well-being interact in women with gestational diabetes mellitus: An integrative review. BMC Pregnancy Childbirth. 2019;19:60. DOI: https://doi.org/10.1186/s12884-019-2185-y

Colicchia LC, Parviainen K, Chang JC. Social contributors to glycemic control in gestational diabetes mellitus. Obstet Gynecol. 2016;128:1333-9. https://doi.org/10.1097/AOG.0000000000001740 PMid:27824747 DOI: https://doi.org/10.1097/AOG.0000000000001740

Attum B, Waheed A, Shamoon Z. Cultural competence in the care of muslim patients and their families. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2020. Available from: http://www.ncbi.nlm.nih.gov/books/NBK499933 [Last accessed on 2020 Apr 12].