PDF(Pubmed)
Abstract：
BACKGROUND: Maternal glycemia is associated with pregnancy outcomes. Thus, supporting the self-management experiences and preferences of pregnant women with type 1 and type 2 diabetes is crucial to optimize glucose control and perinatal outcomes.
METHODS: This paper describes the mixed methods integration of a sequential comparative case study. The objectives are threefold, as we integrated the quantitative and qualitative data within the overall mixed methods design: (1) to determine the predictors of glycemic control during pregnancy; (2) to understand the experience and diabetes self-management support needs during pregnancy among women with pre-existing diabetes; (3) to assess how self-management and support experiences helpe to explain glycemic control among women with pre-existing diabetes in pregnancy. The purpose of the mixing was to integrate the quantitative and qualitative data to develop rich descriptive cases of how diabetes self-management and support experiences and preferences in women with type 1 and type 2 diabetes during pregnancy help explain glucose control. A narrative approach was used to weave together the statistics and themes and the quantitative results were integrated visually alongside the qualitative themes to display the data integration.
RESULTS: The quantitative results found that women achieved \"at target\" glucose control (mean A1C of the cohort by the third visit: 6.36% [95% Confidence Interval 6.11%, 6.60%]). The qualitative findings revealed that feelings of fear resulted in an isolating and mentally exhausting pregnancy. The quantitative data also indicated that women reported high levels of self-efficacy that increased throughout pregnancy. Qualitative data revealed that women who had worked hard to optimize glycemia during pregnancy were confident in their self-management. However, they lacked support from their healthcare team, particularly around self-management of diabetes during labour and delivery.
CONCLUSIONS: The achievement of optimal glycemia during pregnancy was motivated by fear of pregnancy complications and came at a cost to women\'s mental health. Mental health support, allowing women autonomy, and the provision of peer support may improve the experience of diabetes self-management during pregnancy. Future work should focus on developing, evaluating and implementing interventions that support these preferences.
METHODS: This paper describes the mixed methods integration of a sequential comparative case study. The objectives are threefold, as we integrated the quantitative and qualitative data within the overall mixed methods design: (1) to determine the predictors of glycemic control during pregnancy; (2) to understand the experience and diabetes self-management support needs during pregnancy among women with pre-existing diabetes; (3) to assess how self-management and support experiences helpe to explain glycemic control among women with pre-existing diabetes in pregnancy. The purpose of the mixing was to integrate the quantitative and qualitative data to develop rich descriptive cases of how diabetes self-management and support experiences and preferences in women with type 1 and type 2 diabetes during pregnancy help explain glucose control. A narrative approach was used to weave together the statistics and themes and the quantitative results were integrated visually alongside the qualitative themes to display the data integration.
RESULTS: The quantitative results found that women achieved \"at target\" glucose control (mean A1C of the cohort by the third visit: 6.36% [95% Confidence Interval 6.11%, 6.60%]). The qualitative findings revealed that feelings of fear resulted in an isolating and mentally exhausting pregnancy. The quantitative data also indicated that women reported high levels of self-efficacy that increased throughout pregnancy. Qualitative data revealed that women who had worked hard to optimize glycemia during pregnancy were confident in their self-management. However, they lacked support from their healthcare team, particularly around self-management of diabetes during labour and delivery.
CONCLUSIONS: The achievement of optimal glycemia during pregnancy was motivated by fear of pregnancy complications and came at a cost to women\'s mental health. Mental health support, allowing women autonomy, and the provision of peer support may improve the experience of diabetes self-management during pregnancy. Future work should focus on developing, evaluating and implementing interventions that support these preferences.
摘要：
背景：孕妇血糖与妊娠结局相关。因此，支持1型和2型糖尿病孕妇的自我管理经验和偏好对于优化血糖控制和围产期结局至关重要.
方法：本文描述了序贯比较案例研究的混合方法集成。目标有三个方面，我们在整体混合方法设计中整合了定量和定性数据:(1)确定妊娠期血糖控制的预测因素;(2)了解既往糖尿病女性的孕期经历和糖尿病自我管理支持需求;(3)评估自我管理和支持经验如何有助于解释妊娠期糖尿病女性的血糖控制.混合的目的是整合定量和定性数据，以开发丰富的描述性案例，说明怀孕期间1型和2型糖尿病女性的糖尿病自我管理和支持经验和偏好如何帮助解释血糖控制。使用叙述方法将统计数据和主题编织在一起，并将定量结果与定性主题直观地集成在一起，以显示数据集成。
结果：定量结果发现，女性达到了“目标”血糖控制（第三次就诊时队列的平均A1C：6.36％[95％置信区间6.11％，6.60%]）。定性发现表明，恐惧感导致孤立和精神疲惫的怀孕。定量数据还表明，妇女报告的自我效能水平很高，在整个怀孕期间都在增加。定性数据显示，在怀孕期间努力优化血糖的女性对自我管理充满信心。然而,他们缺乏医疗团队的支持，特别是在分娩和分娩期间糖尿病的自我管理。
结论：怀孕期间实现最佳血糖是出于对妊娠并发症的恐惧，并以牺牲妇女的心理健康为代价。心理健康支持,允许女性自主，并且提供同伴支持可能会改善怀孕期间糖尿病自我管理的经验。今后的工作应重点发展,评估和实施支持这些偏好的干预措施。
方法：本文描述了序贯比较案例研究的混合方法集成。目标有三个方面，我们在整体混合方法设计中整合了定量和定性数据:(1)确定妊娠期血糖控制的预测因素;(2)了解既往糖尿病女性的孕期经历和糖尿病自我管理支持需求;(3)评估自我管理和支持经验如何有助于解释妊娠期糖尿病女性的血糖控制.混合的目的是整合定量和定性数据，以开发丰富的描述性案例，说明怀孕期间1型和2型糖尿病女性的糖尿病自我管理和支持经验和偏好如何帮助解释血糖控制。使用叙述方法将统计数据和主题编织在一起，并将定量结果与定性主题直观地集成在一起，以显示数据集成。
结果：定量结果发现，女性达到了“目标”血糖控制（第三次就诊时队列的平均A1C：6.36％[95％置信区间6.11％，6.60%]）。定性发现表明，恐惧感导致孤立和精神疲惫的怀孕。定量数据还表明，妇女报告的自我效能水平很高，在整个怀孕期间都在增加。定性数据显示，在怀孕期间努力优化血糖的女性对自我管理充满信心。然而,他们缺乏医疗团队的支持，特别是在分娩和分娩期间糖尿病的自我管理。
结论：怀孕期间实现最佳血糖是出于对妊娠并发症的恐惧，并以牺牲妇女的心理健康为代价。心理健康支持,允许女性自主，并且提供同伴支持可能会改善怀孕期间糖尿病自我管理的经验。今后的工作应重点发展,评估和实施支持这些偏好的干预措施。
