Endocrine Abstracts

Pre-gestational diabetics frequently rise to the challenge of pregnancy with remarkable improvements in diabetic control. Optimising pregnancy outcomes necessitates rigorous diabetes self-care, which is critically dependent on women’s capacity and the support they receive. The aim of this study was to identify self-reported drivers and inhibitors of self-care in pre-gestational diabetic pregnancies. The study was carried out at a tertiary referral maternity unit. Convenience sampling was used. Ten women were recruited: age range 20–40 years, median age 33 years; nine type 1 diabetics; one type 2 diabetic; duration of diabetes ranged from 1 to 33 years, median was 16.5 years; 6 were unplanned pregnancies; six primigravida; two received diagnosis of foetal complications. Baseline Hba1c ranged from 42 to 85 mmol/l, median was 73 mmol/l. Follow-up measures ranged from 35 to 53 mmol/l, median was 48 mmol/l. Qualitative methods were employed to extract novel insights. We interviewed ten pregnant diabetics using six open-ended questions. Audio recordings were transcribed and ‘computer assisted qualitative data analysis software’ (CAQDAS) assisted coding and analysis of transcripts. Content analysis of transcripts revealed numerous themes. In addition, changes in self-care during pregnancy were measured using a validated questionnaire, ‘Summary of Diabetes Self-Care Activities’ (SDSCA). Nine women reported being highly motivated, driven predominantly by concern for baby’s wellbeing. Numerous challenges were identified: difficulty maintaining a strict diet, hypoglycaemia, turbulent blood glucose and emotional challenges. Women perceived the glycaemic targets as demanding. In contrast numerous supports were perceived to facilitate self-care, particularly the diabetic care team. Other supports were family and the working environment. Regular daily routine was viewed as crucial. The ‘SDSCA’ questionnaire surprisingly did not detect significant changes, yet considerable changes in self-care were reported at interview. In conclusion, pre-gestational diabetic women are highly self-motivated as shown by this qualitative research. ‘SDSCA’ was not sensitive in this setting.