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01-13-2017 | Gestational diabetes | Article

“It’s a Very Big Burden on Me”: Women’s Experiences Using Insulin for Gestational Diabetes

Journal: Maternal and Child Health Journal

Authors: Marlaine Figueroa Gray, Clarissa Hsu, Linda Kiel, Sascha Dublin

Publisher: Springer US



Objectives Gestational Diabetes Mellitus (GDM) affects hundreds of thousands of women each year. Many require medications to manage their blood glucose levels. Only insulin is approved by the U.S. Food and Drug Administration for use in pregnancy. While other medications can be used, their safety remains controversial. Few studies have examined women’s lived experience of using insulin for GDM. Our objective in this study was to foreground the voices of women speaking about their treatment experience. Methods We conducted two focus groups including 16 women treated for GDM with medications, primarily insulin. Topics included women’s experiences with GDM diagnosis and treatment including concerns about risks and benefits of treatments. Transcripts were analyzed using an inductive coding approach. Results Many women had negative experiences with insulin use, such as feeling that they had no voice in treatment decisions, and received inadequate information about insulin, including about the impact it would have on their daily lives. Many continued to have difficulty managing their blood sugar once on insulin, and they worried about the short term and long term health effects of insulin on themselves and their babies. They wanted more information about non-insulin treatment options as well as more social support. Conclusion In our sample of women with GDM, insulin treatment resulted in negative experiences with emotional and experiential impacts lasting beyond pregnancy. There is a need for more research on other medications for GDM, so that women can have access to more treatment options and better information to guide their choices.
Balsells, M., Garcia-Patterson, A., Sola, I., Roque, M., Gich, I., & Corcoy, R. (2015). Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: A systematic review and meta-analysis. BMJ, 350, h102. CrossRefPubMedPubMedCentral
Bandyopadhyay, M., Small, R., Davey, M. A., Oats, J. J., Forster, D. A., & Aylward, A. (2011). Lived experience of gestational diabetes mellitus among immigrant South Asian women in Australia. The Australian & New Zealand Journal of Obstetrics & Gynaecology, 51, 360–364. CrossRef
Berg, M., & Honkasalo, M. L. (2000). Pregnancy and diabetes–a hermeneutic phenomenological study of women’s experiences. Journal of Psychosomatic Obstetrics and Gynaecology, 21, 39–48. CrossRefPubMed
Bernard, H. R. (2005). Research methods in anthropology: Qualitative and quantitative approaches (4th ed.). Lanham, MD: AltaMira Press.
Castillo, W. C., Boggess, K., Sturmer, T., Brookhart, M. A., Benjamin, D. K. Jr., & Funk, M. J. (2015). Association of adverse pregnancy outcomes with glyburide vs insulin in women with gestational diabetes. JAMA Pediatrics, 169, 452–458. CrossRef
Carolan, M. (2013). Women’s experiences of gestational diabetes self-management: A qualitative study. Midwifery, 29, 637–645. CrossRefPubMed
Carolan, M., Gill, G. K., & Steele, C. (2012). Women’s experiences of factors that facilitate or inhibit gestational diabetes self-management. BMC Pregnancy and Childbirth, 12, 99. CrossRefPubMedPubMedCentral
Catalano, P. M., McIntyre, H. D., Cruickshank, J. K., et al. (2012). The hyperglycemia and adverse pregnancy outcome study: Associations of GDM and obesity with pregnancy outcomes. Diabetes Care, 35, 780–786. CrossRefPubMedPubMedCentral
Committee on Practice B-O. (2013). Practice bulletin no. 137: Gestational diabetes mellitus. Obstetrics and Gynecology, 122, 406–416. CrossRef
DeSisto, C. L., Kim, S. Y., & Sharma, A. J. (2014). Prevalence estimates of gestational diabetes mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007–2010. Preventing Chronic Disease, 11, E104. CrossRefPubMedPubMedCentral
Devsam, B. U., Bogossian, F. E., & Peacock, A. S. (2013). An interpretive review of women’s experiences of gestational diabetes mellitus: Proposing a framework to enhance midwifery assessment. Women and Birth: Journal of the Australian College of Midwives, 26, e69–e76. CrossRef
Dhulkotia, J. S., Ola, B., Fraser, R., Farrell, T. (2010) Oral hypoglycemic agents vs insulin in management of gestational diabetes: A systematic review and metaanalysis. American Journal of Obstetrics and Gynecology, 203, e451–e459. CrossRef
Hui, A. L., Sevenhuysen, G., Harvey, D., & Salamon, E. (2014). Stress and anxiety in women with gestational diabetes during dietary management. The Diabetes Educator, 40, 668–677. CrossRefPubMed
International Association of Diabetes Pregnancy Study Groups Consensus Panel, Metzger, B. E., Gabbe, S. G., et al. (2010). International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care, 33, 676–682. CrossRef
Mohsin, M., Bauman, A. E., & Jalaludin, B. (2006). The influence of antenatal and maternal factors on stillbirths and neonatal deaths in New South Wales, Australia. Journal of Biosocial Science, 38, 643–657. CrossRefPubMed
Moretti, M. E., Rezvani, M., & Koren, G. (2008). Safety of glyburide for gestational diabetes: A meta-analysis of pregnancy outcomes. The Annals of Pharmacotherapy, 42, 483–490. CrossRefPubMed
Nicholson, W., Bolen, S., Witkop, C. T., Neale, D., Wilson, L., & Bass, E. (2009). Benefits and risks of oral diabetes agents compared with insulin in women with gestational diabetes: A systematic review. Obstetrics and Gynecology, 113, 193–205. CrossRefPubMed
Nolan, J. A., McCrone, S., & Chertok, I. R. (2011). The maternal experience of having diabetes in pregnancy. Journal of the American Academy of Nurse Practitioners, 23, 611–618. CrossRefPubMed
Parsons, J., Ismail, K., Amiel, S., & Forbes, A. (2014). Perceptions among women with gestational diabetes. Qualitative Health Research, 24, 575–585. CrossRefPubMed
Phung, H., Bauman, A., Tran, M., et al. (2005). Factors that influence special care nursery admissions to a district hospital in South-western Sydney. Journal of Paediatrics and Child Health, 41, 119–124. CrossRefPubMed
Sjogren, B., Robeus, N., & Hansson, U. (1994). Gestational diabetes: A case-control study of women’s experience of pregnancy, health and the child. Journal of Psychosomatic Research, 38, 815–822. CrossRefPubMed