Providing continuity of care with the involvement of midwives also appeared to reduce inequities in care for multi-ethnic patients.
Recommending culturally appropriate diet modifications can improve the quality of care offered to multiethnic women living in low socioeconomic regions who have been diagnosed with diabetes in pregnancy (DiP), according to the results of a study recently published in Women and Birth. Women also felt that community-based continuity-of-care from a midwife was valuable and there are opportunities for midwives to improve care.
“Midwives were the backbone of diabetes in pregnancy care for this multi-ethnic, low socio-economic population,” authors wrote. “Care could be improved with more culturally appropriate diet and lifestyle information, better birth preparation, and expanded postpartum diabetes support.”
Diabetes is the most common complication associated with pregnancy, with risk factors including a body mass index (BMI) of 30 or more, advanced maternal age, polycystic ovarian syndrome, history of gestational or type 2 diabetes mellitus (T2D), and maternal ethnicity. DiPcan be a difficult diagnosis because it requires moderating diet and lifestyle changes, overcoming possible psychological hurdles, and having access to relevant information and health care.
It can be an especially challenging diagnosis for women who come from indigenous or ethnic minority communities in high-income countries, because they tend to have limited access to DiPcare and other resources. However, there is not a lot of information on the experiences of diabetes during pregnancy among women who are multiethnic in a low socio-economic region.
To close this knowledge gap to improve care for all races and ethnicities, investigators conducted a qualitative study to understand the effects of a DiP diagnosis for women who are multiethnic, live in a low socio-economic region, and whose primary access to DiP care is midwife-based. Within this analysis, the team also compared telehealth care with in-person care.
The study population included 19 women from Aotearoa, New Zealand—5 were Māori, 5 were Pacific Peoples, 5 were Asian, and 4 were European. Based on participant responses, investigators observed themes of shock, shame, and adjustment following DiP diagnosis.
Regardless of ethnicity, women were stressed and shocked to receive a DiP diagnosis. Notably, an in-person diagnosis was largely preferred compared with telehealth care because face-to-face time provided women with a better opportunity to learn more information about their condition, and it also facilitated asking questions and feeling more emotional support, which allowed the diagnosis to “feel real,” according to participants.
DiP diagnosis resulted in many women feeling self-blame and community disapproval. However, when they were able to work with a midwife during pregnancy, it allowed them to feel supported and view the diagnosis as incentive to work toward better health and wellbeing, and for some this healthier lifestyle continued post-pregnancy. Therefore, midwife continuity-of-care appeared to reduce inequities in care given to multiethnic patients, according to authors.
This supports previous research that suggests midwife care can improve engagement with healthcare among multiethnic and at-risk patients; however, there was no consistent communication with a midwife following pregnancy. Because of this, “most women become hospital inpatients for induction of labor and during the initial postnatal period,” authors wrote.
In addition, dietary guidance should reflect the different eating habits of different cultures and ethnicities. Patients who are Māori, Pacific, and Asian said that they would have preferred to discuss DiP dietary recommendations with a provider of the same ethnicity and cultural background.
“Somebody said, ‘You need to not eat rice,’ according to 1 participant with a Pacific background. “[But] I’m like, ‘Do you even understand what you are saying?’”
Rice, taro, bread, yam, cassava, and green bananas are staple foods in a Pacific diet, so having somebody who understands cultural context would be helpful to improve care and allow them to continue to enjoy the foods that are culturally important to them. This finding could also apply to any ethnic background—not just those included in the study.
There are limitations to this study, including the use of a small sample size that needed access to an electronic device. This data is also subjective, thus there is a risk of recall bias and responses that were modified to fit social norms. Finally, data were collected during COVID-19, which affected the experience of pregnancy.
Bradford BC, Cronin RS, Okesene-Gafa KA, Apaapa-Timu THS, Shashikumar A, Oyston CJ. Diabetes in pregnancy: Women’s views of care in a multi-ethnic, low socioeconomic population with midwifery continuity-of-care. Women and Birth. Doi: 10.1016/j.wombi.2024.01.005