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Women's and healthcare providers’ perceptions of long‐term complications associated with hypertension and diabetes in pregnancy: a qualitative study
Author(s) -
Nagraj S,
Hinton L,
Praveen D,
Kennedy S,
Norton R,
Hirst J
Publication year - 2019
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.15847
Subject(s) - medicine , focus group , gestational diabetes , thematic analysis , pregnancy , qualitative research , family medicine , health care , diabetes mellitus , disease , type 2 diabetes , obstetrics , nursing , gestation , social science , marketing , endocrinology , sociology , biology , economics , business , genetics , economic growth , pathology
Objectives A diagnosis of hypertensive disorders during pregnancy ( HDP s) 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 ( CHW s), 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 HDP s 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 HDP s 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.