Background: Pregnant women with pre-existing type 2 diabetes (T2DM) are at risk for poor maternal and neonatal outcomes. Previous systematic reviews in women with T2DM have focused on physical activity, blood glucose monitoring, and insulin injections. The purpose of this review was to examine the barriers and facilitators of diabetes self-management.
Method: PubMed, CINAHL, and EMBASE databases were searched using PRISMA-ScR guidelines from January 1, 2009, to July 30, 2019. Inclusion criteria included manuscripts written in English and qualitative studies. Themes were compared and contrasted to identify areas of congruence and discrepancy.
Results: The review included ten manuscripts with 241 pregnant women with pre-existing T2DM, and eight family members were enrolled with sample sizes ranging from 5-89. First, barriers to knowledge about diabetes in pregnancy, physical activity, dietary control, medication adherence, financial constraints, stress, lack of social support, and cultural beliefs. Second, stress related to the diagnosis, infant outcomes, and cultural expectations. Third, barriers to access to care and disrespect from health care providers. Fourth, a loss of self-control. Fifth, facilitators of diabetes self-management in pregnancy were related to support from family, financial support, support from health care providers.
Discussion: Pregnant women with pre-existing T2DM have multiple barriers. Only one manuscript incorporated family members. Further qualitative research may need to seek the perspectives of family members about diabetes self-management in pregnancy and examine how they can provide support to the women.
Conclusion: This supports an integrative model of maternity care to overcome critical barriers and optimize key facilitators to enhance diabetes self-management behaviors and improve maternal and neonatal health outcomes.
R. Phonyiam: None. D.C. Berry: None.