| 1. |
- Persson, Margareta, 1958-, et al.
(författare)
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"Dealing with ambiguity" - the role of obstetricians in gestational diabetes mellitus.
- 2012
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 91:4, s. 439-46
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Gestational diabetes mellitus is a pregnancy-related complication; hence obstetricians counsel and manage the maternal health care for these women. This study describes obstetricians' experiences of management of pregnant women with gestational diabetes mellitus. Design. Interview study. Setting. Hospital-based specialist maternal health care clinics in Sweden. Population. A consecutive purposive national sample of seventeen obstetricians providing maternal health care to pregnant women diagnosed with gestational diabetes mellitus. Methods. Interviews were recorded and transcribed. The data were analyzed using qualitative content analysis. Result. The overall theme describing the experiences of the obstetricians was labeled 'Dealing with ambiguity'. This ambiguity permeated all aspects of working as an obstetrician within the maternal health care; the role of the obstetrician, the context of organization, the multifaceted maternal and fetal interests to balance, and lack of consensus, recommendations and evidence-based knowledge. Conclusions. The study revealed the ambiguous situation experienced and managed by obstetricians providing maternal health care to pregnant women diagnosed with gestational diabetes mellitus. This indicates a need for national guidelines and standardized maternal health care services regarding gestational diabetes mellitus to fulfill the intentions of the health care system. Such recommendations may be beneficial and supportive for the health care professionals as well as for the mother-to-be and her fetus.
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| 2. |
- Persson, Margareta, 1958-, et al.
(författare)
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'From stun to gradual balance' : women's experiences of living with gestational diabetes mellitus
- 2010
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley-Blackwell. - 0283-9318 .- 1471-6712. ; 24:3, s. 454-462
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Tidskriftsartikel (refereegranskat)abstract
- Background and aim: In most parts of the western world, screening routines for gestational diabetes mellitus (GDM) are implemented, however, knowledge of the impact GDM has on the experience of pregnancy and life situation is sparse. The aim of this study was to describe pregnant women's experiences of acquiring and living with GDM during pregnancy. Method: A Grounded Theory approach was used. Ten pregnant women diagnosed with GDM in current pregnancy were interviewed. Data collection was performed in the north of Sweden over two periods; a first set of interviews in 1998-2000 and additional interviews in 2006 to further explore the experience and reach saturation. Findings: 'From stun to gradual balance' emerged as the core category, encompassing of the categories 'Struck by lightning', 'Having a personal responsibility', 'Being under surveillance', 'Struggling for protection', 'Feeling socially apart', 'Being sufficiently supported', 'Changing the self-image', 'Adapting to a new situation' and 'Waiting for the 'Moment of truth''. Our findings indicated that the diagnosis of GDM initiated a number of challenges and demands for the pregnant women. Further, being diagnosed with GDM was not only perceived as a medical complication threatening the pregnancy, moreover as an indicator of a future diabetes mellitus. Conclusion: The experience of being diagnosed with and living with GDM during pregnancy may be understood as a process 'from stun to gradual balance'. The experience comprises positive and negative dimensions. Despite the challenges, the inconveniences and the changes involved, gradually adapting to a lifestyle and balancing the every day life is the prize most of these women are willing to pay in order to secure optimal maternal and foetal health. Knowledge of the experiences of women diagnosed with GDM may enable midwives to provide increased support as well as provide information and preventive measures in order to delay future diabetes mellitus.
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| 3. |
- Persson, Margareta, et al.
(författare)
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Lifestyle and health status in a sample of Swedish women four years after pregnancy: a comparison of women with a history of normal pregnancy and women with a history of gestational diabetes mellitus
- 2015
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Ingår i: Bmc Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite the recommendations to continue the regime of healthy food and physical activity (PA) postpartum for women with previous gestational diabetes mellitus (GDM), the scientific evidence reveals that these recommendations may not be complied to. This study compared lifestyle and health status in women whose pregnancy was complicated by GDM with women who had a normal pregnancy and delivery. Methods: The inclusion criteria were women with GDM (ICD-10: O24.4 A and O24.4B) and women with uncomplicated pregnancy and delivery in 2005 (ICD-10: O80.0). A random sample of women fulfilling the criteria (n = 882) were identified from the Swedish Medical Birth Register. A questionnaire was sent by mail to eligible women approximately four years after the pregnancy. A total of 444 women (50.8%) agreed to participate, 111 diagnosed with GDM in their pregnancy and 333 with normal pregnancy/ delivery. Results: Women with previous GDM were significantly older, reported higher body weight and less PA before the index pregnancy. No major differences between the groups were noticed regarding lifestyle at the follow-up. Overall, few participants fulfilled the national recommendations of PA and diet. At the follow-up, 19 participants had developed diabetes, all with previous GDM. Women with previous GDM reported significantly poorer self-rated health (SRH), higher level of sick-leave and more often using medication on regular basis. However, a history of GDM or having overt diabetes mellitus showed no association with poorer SRH in the multivariate analysis. Irregular eating habits, no regular PA, overweight/obesity, and regular use of medication were associated with poorer SRH in all participants. Conclusions: Suboptimal levels of PA, and fruit and vegetable consumption were found in a sample of women with a history of GDM as well as for women with normal pregnancy approximately four years after index pregnancy. Women with previous GDM seem to increase their PA after childbirth, but still they perform their PA at lower intensity than women with a history of normal pregnancy. Having GDM at index pregnancy or being diagnosed with overt diabetes mellitus at follow-up did not demonstrate associations with poorer SRH four years after delivery.
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| 4. |
- Persson, Margareta, 1958-, et al.
(författare)
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"Mission Impossible"? Midwives' experiences counseling pregnant women with gestational diabetes mellitus.
- 2011
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Ingår i: Patient Education and Counseling. - Princeton : Elsevier BV. - 0738-3991 .- 1873-5134. ; 84:1, s. 78-83
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Since not all pregnancy-related complications require hospitalization midwives often provide these women with antenatal care and counseling. This study explored the experiences of midwives providing antenatal care and counseling to pregnant women with gestational diabetes mellitus (GDM). METHODS: Twelve midwives participated in the interview study performed in the three northernmost counties in Sweden. Grounded theory was used for analysis. RESULTS: The emerging core category was 'Balancing fear of failure'. The unexpected disease increased the demands and the pressure. Three major conflicting situations were revealed. The midwives believed they were obligated to monitor and control the pregnancy, to initiate and motivate the necessary changes in lifestyle and provide empowering relationships with their patients. The fear of failure with these assignments made the midwives chose different strategies to manage the conflicting situations. CONCLUSIONS AND PRACTICE IMPLICATIONS: The midwives described conflicting encounters providing antenatal care to pregnant women with GDM. The fear of failing to fulfill the assignments caused by the GDM made the midwives chose strategies to handle the conflicting encounters. Similar conflicting situations might be present for other health care professionals promoting lifestyle changes. The challenges might be addressed with an organization focusing on support and coaching sessions.
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| 5. |
- Persson, Margareta, et al.
(författare)
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[No unified guidelines concerning gestational diabetes in Sweden. Noticeable differences between screening, diagnostics and management in maternal health services]
- 2007
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 104:45, s. 3365-9
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Tidskriftsartikel (refereegranskat)abstract
- In Sweden, there are noticeable differences between the antenatal health care settings concerning the prevalence of oral glucose tolerance tests (OGTT) to detect gestational diabetes mellitus (GDM). Clinical guidelines for screening, diagnostics and treatment of GDM 2004 were collected from all antenatal health care areas (n=50, 100% of eligible areas) in Sweden. The guidelines were analysed in relation to the available national statistics. The most prominent finding was that there was no consensus on screening, diagnosis and treatment of GDM. In most areas, the well-known risk factors for GDM were used as the criteria for offering OGTT to pregnant women. However, some areas offered OGTT to all pregnant women, resulting in a significantly greater detection of GDM. Hence, it is likely that the reported prevalence of GDM in Sweden is an underestimate. We suggest that national guidelines for screening, diagnosis and treatment of GDM should be developed in order to better fulfil the intentions of the Swedish National Board of Health and Welfare.
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| 6. |
- Persson, Margareta, 1958-, et al.
(författare)
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Surprisingly low compliance to local guidelines for risk factor based screening for gestational diabetes mellitus - A population-based study.
- 2009
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Ingår i: BMC pregnancy and childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: Screening for gestational diabetes mellitus (GDM) is routine during pregnancy in many countries in the world. The screening programs are either based on general screening offered to all pregnant women or risk factor based screening stipulated in local clinical guidelines. The aims of this study were to investigate: 1)the compliance with local guidelines of screening for GDM and 2)the outcomes of pregnancy and birth in relation to risk factors of GDM and whether or not exposed to oral glucose tolerance test (OGTT). METHODS: This study design was a population-based retrospective cross-sectional study of 822 women. A combination of questionnaire data and data collected from medical records was applied. Compliance to the local guidelines of risk factor based screening for GDM was examined and a comparison of outcomes of pregnancy and delivery in relation to risk factor groups for GDM was performed. RESULTS: Of the 822 participants, 257 (31.3%) women fulfilled at least one criterion for being exposed to screening for GDM according to the local clinical guidelines. However, only 79 (30.7%) of these women were actually exposed to OGTT and of those correctly exposed for screening, seven women were diagnosed with GDM. Women developing risk factors for GDM during pregnancy had a substantially increased risk of giving birth to an infant with macrosomia. CONCLUSION: Surprisingly low compliance with the local clinical guidelines for screening for GDM during pregnancy was found. Furthermore, the prevalence of the risk factors of GDM in our study was almost doubled compared to previous Swedish studies. Pregnant women developing risk factors of GDM during pregnancy were found to be at substantially increased risk of giving birth to an infant with macrosomia. There is a need of actions improving compliance to the local guidelines.
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