Clinical Studies
Relationships Between the Perceived Impact of Gestational Diabetes Mellitus and Treatment Adherence

https://doi.org/10.1111/j.1552-6909.1996.tb02119.xGet rights and content

Approximately 10% to 20% of all pregnancies in the United States are labeled high risk. High-risk pregnancies account for more than half of all fetal and neonatal deaths in the United States (Pernall, Benda,Babson, & Simpson, 1986). Risk is a label used to indicate physiologic, psychologic, individual, or environmental factors that exist during pregnancy and pose some threat to the health of the mother or fetus. Gestational diabetes mellitus is recognized as a high-risk condition for pregnant women because of the potential for increased maternal and fetal morbidity and mortality related to the disease. Gestational diabetes mellitus affects more than 90,000 pregnancies per year in the United States (Sepe, Connell, Geiss, & Teutsch, 1985). Inadequate glucose control, inadequate fetal surveillance, or failure to adhere to the prescribed treatment plan can complicate pregnancy. In such a case, the pregnant woman with gestational diabetes and her infant are placed at considerable physical and psychologic risk (Levin et al., 1986, J et al., 1985

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Theoretical Framework

Many theoretical models have been proposed for the study of stressful life events similar to the diagnosis of gestational diabetes mellitus. However, most models examine only the relationship between an event and the stress response, or the event and a patient’s perception of the event. Investigation must go beyond these relationships to the consequences of the stressors. Therefore, the theoretical model chosen to guide this study is adapted from the report of the Institute of Medicine on

Literature Review

Maternal emotional factors have been shown to influence the course and outcome of pregnancy (Eliot & Eisdorfer, 1982). The treatment of gestational diabetes mellitus, which involves rigorous lifestyle changes for many women, has been documented to be stressful (Samson, Arnold, & Gibbons, 1986). The pregnant women surveyed by Samson and colleagues reported stress resulting from their health restoration program. Women’s greatest concern was controlling their glucose levels. The women surveyed

Method

The study was conducted in a large, urban, tertiary perinatal center in the northeast. Participants were 29 women with gestational diabetes mellitus who were enrolled in a larger study of early discharge and nurse specialist transitional care. All women in the convenience sample met the following criteria: English speaking, telephone access at home, primary diagnosis of gestational diabetes mellitus, and less than 36 weeks gestation. Patients were approached by the investigator and asked to

Results

Data were subjected to appropriate descriptive and correlational analysis. A generous alpha of .10 was used for significance testing. This alpha level, set before the data analysis, was used because of the exploratory nature of the study. Analysis of the scores on the Impact of Event Scale revealed a mean and standard deviation of 27.9 and 13.8, respectively. The mean score on the Impact of Event Scale in this sample, although lower than the mean score of 43.7 reported by Horowitz et al. (1979)

Discussion

Participants in this study were primarily low-income, unmarried, black women. A review of epidemiologic literature illustrates the disproportionate levels of infant morbidity and mortality, maternal death during pregnancy, and general illness in this population. Dutton (1986) describes the cycle of poverty and illness that includes low income, inadequate education, and hazardous occupations leading to poor environmental conditions, psychologic stress, and social isolation, which can, in turn,

Clinical Implications

The women enrolled in this study reported that gestational diabetes mellitus had a significant impact on their lives. The important consideration for health care providers when caring for women with this condition is, however, not only the specific reactions that women have to the stressor of gestational diabetes mellitus, but also the behavioral consequences of those reactions. Behavior has been documented to play an important role in health. Health care providers spend a lot of time trying to

Recommendations for Future Research

From this research, a profile emerged of a vulnerable population of women who are black, single, urban, lowincome, and experiencing a high-risk pregnancy. This population is already at high risk of poor birth outcomes because of minority status and social class. With the additional stressor of a high risk pregnancy that requires significant behavioral modification to optimize outcome, the coping behaviors of the women are tested. Further study is warranted of the reactions of women to the

Acknowledgments

A portion of this work was supported by a grant (P01-NR-01859) from the National Center for Nursing Research, National Institutes of Health. This article received Honorable Mention in the Clinical Research Paper category at the AWHONN 1994 Convention, Cincinnati, OH.

References (24)

  • S. Gabbe et al.

    Management and outcome of class A diabetes

    American Journal of Obstetrics and Gynecology

    (1977)
  • N. Burns et al.

    The practice of nursing research

    (1993)
  • T. Cabalum et al.
  • A. Cerkoney et al.

    The relationship between the health belief model and compliance of persons with diabetes mellitus

    Diabetes Care

    (1980)
  • D. Dutton

    Social class, health and illness

  • Gestation and Diabetes in France Study Group

    Multicenter survey of diabetic pregnancy in France

    Diabetes Care

    (1991)
  • T. Glasgow et al.

    Self care behaviors and glycemic control in Type I diabetes

    Journal of Chronic Disease

    (1987)
  • M. Horowitz et al.

    Impact of Event Scale: A measure of subjective stress

    Psychosomatic Medicine

    (1979)
  • M. Levin et al.

    Pregnancy and diabetes: A team approach

    Archives of Internal Medicine

    (1986)
  • B. Masek

    Compliance and medicine

  • D. Meichenbaum et al.

    Facilitating treatment adherence: A practitioner’s guidebook

    (1987)
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