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Barriers to Managing Diabetes During Pregnancy: The Perceptions of Health Care Practitioners

Authors

  • Patricia Mersereau MN, CPNP,

    1. Patricia Mersereau is a Health Communication Specialist with SciMetrika, L.L.C., for the U.S. Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities (NCBDDD); Jennifer Williams is a Commander in the U.S. Public Health Service and a Nurse Epidemiologist at CDC, NCBDDD; Sarah Collier is an Analytic Epidemiologist with Atlanta Research and Education Foundation for CDC, National Center for Emerging and Zoonotic Infectious Diseases (NCZVED); Celine Mulholland is a Medical Student at the University of California, Los Angeles, California; Khadija Turay is a Doctoral Candidate at the University of North Carolina at Chapel Hill, North Carolina; Christine Prue is Associate Director for Behavioral Science (Acting), CDC, NCZVED, Atlanta, Georgia, United States of America.
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  • Jennifer Williams MSN, MPH, FNP-BC,

    1. Patricia Mersereau is a Health Communication Specialist with SciMetrika, L.L.C., for the U.S. Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities (NCBDDD); Jennifer Williams is a Commander in the U.S. Public Health Service and a Nurse Epidemiologist at CDC, NCBDDD; Sarah Collier is an Analytic Epidemiologist with Atlanta Research and Education Foundation for CDC, National Center for Emerging and Zoonotic Infectious Diseases (NCZVED); Celine Mulholland is a Medical Student at the University of California, Los Angeles, California; Khadija Turay is a Doctoral Candidate at the University of North Carolina at Chapel Hill, North Carolina; Christine Prue is Associate Director for Behavioral Science (Acting), CDC, NCZVED, Atlanta, Georgia, United States of America.
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  • Sarah A. Collier MPH,

    1. Patricia Mersereau is a Health Communication Specialist with SciMetrika, L.L.C., for the U.S. Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities (NCBDDD); Jennifer Williams is a Commander in the U.S. Public Health Service and a Nurse Epidemiologist at CDC, NCBDDD; Sarah Collier is an Analytic Epidemiologist with Atlanta Research and Education Foundation for CDC, National Center for Emerging and Zoonotic Infectious Diseases (NCZVED); Celine Mulholland is a Medical Student at the University of California, Los Angeles, California; Khadija Turay is a Doctoral Candidate at the University of North Carolina at Chapel Hill, North Carolina; Christine Prue is Associate Director for Behavioral Science (Acting), CDC, NCZVED, Atlanta, Georgia, United States of America.
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  • Celene Mulholland MPH,

    1. Patricia Mersereau is a Health Communication Specialist with SciMetrika, L.L.C., for the U.S. Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities (NCBDDD); Jennifer Williams is a Commander in the U.S. Public Health Service and a Nurse Epidemiologist at CDC, NCBDDD; Sarah Collier is an Analytic Epidemiologist with Atlanta Research and Education Foundation for CDC, National Center for Emerging and Zoonotic Infectious Diseases (NCZVED); Celine Mulholland is a Medical Student at the University of California, Los Angeles, California; Khadija Turay is a Doctoral Candidate at the University of North Carolina at Chapel Hill, North Carolina; Christine Prue is Associate Director for Behavioral Science (Acting), CDC, NCZVED, Atlanta, Georgia, United States of America.
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  • Khadija Turay MPH,

    1. Patricia Mersereau is a Health Communication Specialist with SciMetrika, L.L.C., for the U.S. Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities (NCBDDD); Jennifer Williams is a Commander in the U.S. Public Health Service and a Nurse Epidemiologist at CDC, NCBDDD; Sarah Collier is an Analytic Epidemiologist with Atlanta Research and Education Foundation for CDC, National Center for Emerging and Zoonotic Infectious Diseases (NCZVED); Celine Mulholland is a Medical Student at the University of California, Los Angeles, California; Khadija Turay is a Doctoral Candidate at the University of North Carolina at Chapel Hill, North Carolina; Christine Prue is Associate Director for Behavioral Science (Acting), CDC, NCZVED, Atlanta, Georgia, United States of America.
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  • Christine Prue PhD, MSPH

    1. Patricia Mersereau is a Health Communication Specialist with SciMetrika, L.L.C., for the U.S. Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities (NCBDDD); Jennifer Williams is a Commander in the U.S. Public Health Service and a Nurse Epidemiologist at CDC, NCBDDD; Sarah Collier is an Analytic Epidemiologist with Atlanta Research and Education Foundation for CDC, National Center for Emerging and Zoonotic Infectious Diseases (NCZVED); Celine Mulholland is a Medical Student at the University of California, Los Angeles, California; Khadija Turay is a Doctoral Candidate at the University of North Carolina at Chapel Hill, North Carolina; Christine Prue is Associate Director for Behavioral Science (Acting), CDC, NCZVED, Atlanta, Georgia, United States of America.
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  • The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention.

Address correspondence to Patricia Mersereau, RN, MN, CPNP, Scimetrika Contractor for CDC, NCBDDD, 1600 Clifton Road, NE, MS E-86, Atlanta, GA 30333, USA.

Abstract

Abstract:  Background:  Uncontrolled pregestational diabetes in pregnancy is associated with an increased risk for a major birth defect and additional adverse pregnancy outcomes. The study objective was to investigate the concerns of health care practitioners who care for women with a history of diabetes during pregnancy and their perceptions of attitudes and barriers to achieving good glycemic control.

Methods:  Focus groups were conducted with physicians, midlevel practitioners, and certified diabetes educators in Atlanta, Georgia. Practitioners were eligible if they actively practiced, primarily in outpatient facilities in Atlanta, and were neither students nor interns. Six focus groups, two of each practitioner type, were conducted.

Results:  Practitioners stated that few of their patients planned their pregnancies. Practitioners perceived that pregnant women were concerned primarily about their babies and might not be aware of complications with their personal health. Their perceptions of the greatest barriers to glycemic control for women involved lack of knowledge, lack of access, and attitude.

Conclusions:  Educating women with diabetes about the importance of using effective birth control until they have achieved good glycemic control can help reduce the risk for adverse pregnancy outcomes. Motivators and barriers for a woman with diabetes to achieve glycemic control before, during, and after pregnancy should be considered when developing approaches to improve outcomes. Helping practitioners know what and how to address the needs of childbearing women with or at risk for diabetes can be beneficial. Additional efforts to increase women’s knowledge about diabetes and pregnancy and to develop effective strategies to encourage women’s achievement and maintenance of glycemic control before, during, and after pregnancy are needed. (BIRTH 38:2 June 2011)

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