Healthcare professional perspectives on improving inter-pregnancy care after a baby loss for women with type 1 and type 2 diabetes

IF 3.2 3区医学 Q2 ENDOCRINOLOGY & METABOLISM Diabetic Medicine Pub Date : 2024-07-01 DOI:10.1111/dme.15401

Eleanor Dyer, Ruth Bell, Ruth Graham, Judith Rankin

{"title":"Healthcare professional perspectives on improving inter-pregnancy care after a baby loss for women with type 1 and type 2 diabetes","authors":"Eleanor Dyer, Ruth Bell, Ruth Graham, Judith Rankin","doi":"10.1111/dme.15401","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aims</h3>\n \n <p>Women with diabetes (WWD) (type 1 and type 2) are around four times more likely to experience baby loss: miscarriage, stillbirth, neonatal death or termination of pregnancy for medical reasons. Many WWD become pregnant again soon after loss. This study aimed to explore healthcare professional perspectives on improving inter-pregnancy care for WWD after baby loss, as they play a crucial role in facilitating access to support for WWD to prepare for subsequent pregnancy.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Eighteen healthcare professionals recruited through social media and professional networks between November 2020 and July 2021 participated in a semi-structured remote interview. Data were analysed using thematic analysis.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Three main themes were identified: (1) supporting WWD who want to become pregnant again after baby loss; (2) recognising multiple hidden burdens in the inter-pregnancy interval after loss; (3) discontinuities and constraints in inter-pregnancy care. Most participants tended to assume WWD wanted time and space before thinking about pregnancy after loss, so they did not routinely broach the subject. Participants reported receiving little or no training on managing sensitive conversations. Care provision varied across providers, and unclear referral pathways were challenging to navigate. Participants reported concerns that not all healthcare professionals knew how to mitigate pregnancy risks.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>It is unclear who is responsible for supporting WWDs preconception health between baby loss and subsequent pregnancy. Healthcare professionals may be reticent to initiate conversations about pregnancy for fear of causing upset or distress. Future research is required to scope out ways to raise awareness among healthcare professionals and practical tips on sensitively raising the topic of subsequent pregnancy.</p>\n </section>\n </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15401","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diabetic Medicine","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/dme.15401","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

Abstract

Aims

Women with diabetes (WWD) (type 1 and type 2) are around four times more likely to experience baby loss: miscarriage, stillbirth, neonatal death or termination of pregnancy for medical reasons. Many WWD become pregnant again soon after loss. This study aimed to explore healthcare professional perspectives on improving inter-pregnancy care for WWD after baby loss, as they play a crucial role in facilitating access to support for WWD to prepare for subsequent pregnancy.

Methods

Eighteen healthcare professionals recruited through social media and professional networks between November 2020 and July 2021 participated in a semi-structured remote interview. Data were analysed using thematic analysis.

Results

Three main themes were identified: (1) supporting WWD who want to become pregnant again after baby loss; (2) recognising multiple hidden burdens in the inter-pregnancy interval after loss; (3) discontinuities and constraints in inter-pregnancy care. Most participants tended to assume WWD wanted time and space before thinking about pregnancy after loss, so they did not routinely broach the subject. Participants reported receiving little or no training on managing sensitive conversations. Care provision varied across providers, and unclear referral pathways were challenging to navigate. Participants reported concerns that not all healthcare professionals knew how to mitigate pregnancy risks.

Conclusions

It is unclear who is responsible for supporting WWDs preconception health between baby loss and subsequent pregnancy. Healthcare professionals may be reticent to initiate conversations about pregnancy for fear of causing upset or distress. Future research is required to scope out ways to raise awareness among healthcare professionals and practical tips on sensitively raising the topic of subsequent pregnancy.

Abstract Image

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

医护专业人员对改善 1 型和 2 型糖尿病妇女失去婴儿后的孕间护理的看法。

目的：患有糖尿病（1 型和 2 型）的妇女失去婴儿的几率要高出四倍左右：流产、死产、新生儿死亡或因医疗原因终止妊娠。许多妇女在流产后不久又怀孕了。本研究旨在探讨医护专业人员对改善丧婴后世界女性病患者孕间护理的看法，因为医护专业人员在促进世界女性病患者获得支持以准备后续怀孕方面发挥着至关重要的作用：在 2020 年 11 月至 2021 年 7 月期间，通过社交媒体和专业网络招募的 18 名医疗保健专业人员参加了半结构化远程访谈。采用主题分析法对数据进行分析：结果：确定了三大主题：(1) 为失去婴儿后希望再次怀孕的妇女病患提供支持；(2) 认识到失去婴儿后怀孕间隔期的多重隐性负担；(3) 怀孕间隔期护理的不连续性和制约因素。大多数参与者倾向于认为丧偶妇女需要时间和空间来考虑丧偶后怀孕的问题，因此他们并不经常提起这个话题。据参与者报告，他们很少或根本没有接受过关于如何处理敏感对话的培训。不同医疗服务提供者提供的医疗服务各不相同，转诊途径不明确，这给患者带来了挑战。参与者担心并非所有的医护人员都知道如何降低妊娠风险：目前还不清楚在失去婴儿和随后怀孕期间，谁应负责为世界女性提供孕前健康支持。医护人员可能会因为害怕引起不安或痛苦而不愿主动谈论怀孕问题。今后需要开展研究，找出提高医护人员认识的方法，以及以敏感方式提出再次怀孕话题的实用技巧。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Diabetic Medicine 医学-内分泌学与代谢

CiteScore

7.20

自引率

5.70%

发文量

229

审稿时长

3-6 weeks

期刊介绍： Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”