Women with type 1 diabetes during pregnancy and postpartum Well-being and diabetes management

Sammanfattning: Type 1 diabetes mellitus (T1DM) is associated with increased medical risks during pregnancy and birth. To minimize the risks and increase the possibility of a healthy offspring, blood glucose levels near normal are required. This puts women with T1DM in a vulnerable situation in relation to pregnancy and childbirth, as it demands high levels of diabetes management. The overall aim was to investigate well-being and diabetes management in women with T1DM during pregnancy and in the first six months postpartum. Studies I, II and III mainly report on patient-reported outcome measures in terms of questionnaires. Studies I and III have an observational design and Study II was a randomized controlled trial. Study IV used a case study design and analysed data with both quantitative and qualitative methods. In Study I, well-being and diabetes management in early pregnancy was explored. A higher degree of diabetes management correlated positively with self-perceived health and well-being and with less worry about diabetes distress and hypoglycemia. In Study II, a web-based support program during pregnancy and up to six months after childbirth was evaluated. The findings suggest that the web-based support and standard care was not superior to standard care alone in terms of general well-being or self-efficacy of diabetes management at six months postpartum and that few participants had a high activity level. In Study III, associations between well-being, diabetes management and breastfeeding postpartum were investigated. Participants with lower scores of general well-being and sense of coherence expressed a need for more professional support to manage their diabetes than they were offered. In Study IV, adherence to technological elements and study design in a web-based intervention were critically analysed. The results highlight that technology and study design matter and might mutually influence each other. The findings confirm that well-being and diabetes management are closely linked during the childbearing period. Means of identifying a more vulnerable group of women with T1DM during pregnancy and new approaches to professional support after childbirth are needed.