Experience with advice about diet and self-monitoring of blood glucose of women with gestational diabetes mellitus: Qualitative study

Abstract

Background: Gestational Diabetes Mellitus (GDM), defined as hyperglycemia detected at any time during pregnancy, is increasing worldwide. In 2017, new guidelines for the care of women with GDM were implemented in Norway. Prior to the implementation of these guidelines, women with GDM were followed-up in secondary health care. One of the main aims of these guidelines was that more women with GDM shall be followed-up in primary health care. First-line management of GDM involves dietary advice based on women’s regularly measured blood glucose levels. 70-85% of women diagnosed with GDM may manage the disease with lifestyle changes, such as healthy eating and physical activity. However, lifestyle changes presuppose knowledge, motivation, and follow-up by health care professionals. Little is known about how women receive this follow-up. The aim of this thesis was to explore how women with GDM experience advice about diet and self-management of blood glucose received in primary health care and secondary health care, with specific focus on how women perceived the collaboration between health care professionals. Methods: Women in the study were purposely recruited. Semi-structured interviews were conducted with 12 women in area of Oslo, Norway in the period September 2019-Februar 2020. The interviews were tape-recorded and transcribed verbatim. The data were analysed with thematic analysis. Results: Women described being diagnosed with GDM with a feeling of shock and felt an immediate need for information about the consequences and management of GDM. Most of the women experienced that their general practitioner had too little knowledge about GDM to answer their questions. Especially women of immigrant background felt that midwives in the primary health care provided them with sufficient dietary advice related to GDM, whereas ethnic Norwegian women often asked for more individually tailored dietary advice, as perceived to receive in secondary health care. Self-monitoring of blood glucose influenced women’s daily lives, however, they perceived the training in primary -and secondary health care as sufficient. Women experienced poor collaboration between health care professionals in primary and secondary health care, which implied that they sometimes had to initiate follow-up steps in their GDM care by themselves. Conclusions: Women diagnosed with GDM should meet health care professionals with sufficient knowledge about GDM immediately after being diagnosed. The collaboration between health care professionals involved in the care of women with GDM should be improved to avoid that the women themselves feel the need to coordinate their care.