Women's and healthcare providers' perceptions of long-term complications associated with hypertension and diabetes in pregnancy: a qualitative study
Women's and healthcare providers' perceptions of long-term complications associated with hypertension and diabetes in pregnancy: a qualitative study
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DOI：
10.1111/1471-0528.15847
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发表时间：
2019-08-16
影响因子：
5.8
通讯作者：
Hirst, J.
中科院分区：
文献类型：
--
作者：
Nagraj, S.;Hinton, L.;Hirst, J.
目的 妊娠期高血压疾病 (HDP) 或妊娠糖尿病 (GDM) 的诊断可以高度预测女性患慢性高血压、2 型糖尿病和心血管疾病的风险增加。这项研究调查了印度农村妇女和医疗保健提供者对这些长期风险的看法。使用修正的扎根理论设计定性研究。设置印度农村的两个邦：哈里亚纳邦和安得拉邦。人群 孕妇和产后妇女、社区卫生工作者 (CHW)、初级保健医生、产科医生、实验室技术人员和医疗保健官员。方法通过深度访谈和焦点小组讨论探讨：（1）高危孕妇的优先事项； (2) HDP和GDM的检测和管理； (3) 产后管理，(4) 了解高风险情况的长期后遗症。进行了主题分析。结果 进行了 7 次焦点小组讨论和 11 次深度访谈（n = 71 名参与者）。高危孕妇的重点优先领域是贫血。血压测量已常规纳入产前护理；然而，产后随访和对长期并发症的了解有限。尽管 GDM 筛查存在显着差异和挑战，但 GDM 并不被认为是一个常见问题。医生对 GDM 长期后遗症与 2 型糖尿病和心血管疾病风险增加相关的了解甚少。结论 印度农村地区需要改善 HDP 和 GDM 的教育、测试标准化和产后随访。 SN 的资金由 MRC 临床研究培训奖学金 (MR/R017182/1) 提供支持。乔治全球健康研究所的全球妇女健康项目为印度的研究助理和实地考察费用提供了财政支持。印度农村地区妊娠期患有高血压和糖尿病的妇女需要改善教育和产后护理，以预防长期风险。
Objectives A diagnosis of hypertensive disorders during pregnancy (HDPs) or gestational diabetes mellitus (GDM) is highly predictive of women at increased risk of developing chronic hypertension, Type 2 diabetes, and cardiovascular disease. This study investigates perceptions of women and healthcare providers in rural India regarding these long-term risks. Design Qualitative study using modified grounded theory. Setting Two states in rural India: Haryana and Andhra Pradesh. Population Pregnant and postpartum women, community health workers (CHWs), primary care physicians, obstetricians, laboratory technicians, and healthcare officials. Methods In-depth interviews and focus group discussions explored: (1) priorities for high-risk pregnant women; (2) detection and management of HDPs and GDM; (3) postpartum management, and (4) knowledge of long-term sequelae of high-risk conditions. A thematic analysis was undertaken. Results Seven focus group discussions and 11 in-depth interviews (n = 71 participants) were performed. The key priority area for high-risk pregnant women was anaemia. Blood pressure measurement was routinely embedded in antenatal care; however, postpartum follow up and knowledge of the long-term complications were limited. GDM was not considered a common problem, although significant variations and challenges to GDM screening were identified. Knowledge of the long-term sequelae of GDM with regard to an increased risk of Type 2 diabetes and cardiovascular disease among doctors was minimal. Conclusions There is a need for improved education, standardisation of testing and postpartum follow up of HDPs and GDM in rural Indian settings. Funding SN is supported by an MRC Clinical Research Training Fellowship (MR/R017182/1). The George Institute for Global Health Global Women's Health programme provided financial support for the research assistant and fieldwork costs in India. Tweetable abstract Improved education and postpartum care of women with hypertension and diabetes in pregnancy in rural India are needed to prevent long-term risks.