The Directorate of Health is responsible for the National Guideline for Gestational Diabetes in Norway. In conjunction with a possible new update, the Department of Health Services at the Institute of Public Health has been commissioned to produce a systematic mapping review on the effect and experience with communication- and education interventions for women with gestational diabetes.
We performed a systematic mapping review. In May 2019, a librarian searched various databases for empirical studies. Two researchers independently assessed the identified references from the search. We have presented the data in text, tables and figures.
We included 25 studies; 12 studies about effect and 13 about experiences regarding communication and education for women with gestational diabetes Five systematic reviews had a very broad question and did not specifically deal with communication. Seven primary studies investigated the effect of various educational interventions with elements such as diet, physical activity, glucose measurement and self-management. One review of qualitative studies describes the experiences of pregnant women with diabetes and treatment experience. Five studies examined the health professionals' experiences of providing information. Two of the studies were conducted in Sweden and two in Norway. Seven studies, mostly using interviewing methods, investigated women's experiences. The studies were conducted in Australia, the United Kingdom and Sweden.
Gestational diabetes (GDM) can develop during pregnancy and results in increased blood sugar levels. The need for insulin naturally increases during pregnancy. Gestational diabetes develops if the production of insulin does not match the increase in demand and occurs if the body´s insulin production does not increase sufficiently during pregnancy. Gestational diabetes can develop without given symptoms in addition to normal symptoms of pregnancy. Additionally, being diagnosed with gestational diabetes can be a surprise and may cause anxiety. The woman´s knowledge and understanding of gestational diabetes can affect the extent to which the woman follows health recommendations and treatment. Untreated, the condition can be harmful to both mother and child. Most women want the best for their child and are willing to follow recommended treatment. Treatment may include lifestyle changes such as physical activity and changed diet, regular measurements of blood sugar levels and potentially medication.
Medicalisation of pregnancy may lead to a shift from positive feelings and expectations to increased concerns about foetus health and developing gestational diabetes. In addition, it may be difficult to follow recommendations on diet and measurements of blood sugar levels in various social settings. It is important to understand the factors that influence women's behaviour and perceptions throughout pregnancy, so women with gestational diabetes can receive the best care.
The Directorate of health asked the Institute of Public Health to map out both quantitative and qualitative evidence about communication and education for women with gestational diabetes.
We followed a predefined protocol to prepare this systematic mapping review of quantitative and qualitative evidence about communication- and education interventions for women with gestational diabetes. We used the inclusion criteria below.
Inclusion criteria for the question about effect of communication- and education interventions for woman with gestation diabetes
Population: Women with gestational diabetes living in high- income countries. Studies from other countries were recorded in a table.
Outcome: Compliance with diet-recommendations, self- measurement of blood sugar
level, screening for diabetes type 2 after pregnancy, pre-eclampsia, large for gestational
Language: Danish, English, Norwegian, Swedish.
Study design: Systematic reviews, primary studies with the following designs: randomized controlled trials, prospective studies with a control group, before and after studies, interrupted time series. In addition, we also evaluated cross-sectional studies and observational studies without control group for the qualitative part of this mapping review.
Exclusion criteria: Information material, e.g. web sides, videos, written material.
Inclusion criteria for the question about experiences of receiving communication- and education interventions for woman with gestation diabetes
Population: Women with gestational diabetes living in high-income countries and health personnel (doctor, midwife and nurse) who gave communication and education interventions. Studies about woman’s experience with GDM not related to communication, such as the identification of barriers and facilitators were listed.
Outcome: Woman’s experiences, both positive and negative e.g. worry anxiety, stress,
nausea, self-management and relief.
Health personnel’s experiences e.g. pathologies and benefits, barriers and facilitators.
Language: Danish, English, Norwegian, Swedish.
Study design: Systematic reviews of qualitative literature, qualitative research and qualitative research about women’s and health personnel’s experiences related to communication about gestational diabetes.
We included 25 publications (6 systematic reviews and 19 primary studies) about communication and education for women with gestational diabetes. Twelve studies about effect and 13 about experience regarding communication and education for women with gestational diabetes. We excluded 131 studies, 28 studies were conducted in low or middle-income countries (LMIC) and 17 studies investigated woman’s experience with GDM, not related to communication, facilitators or barriers.
We included five systematic reviews and seven primary studies about the effect of communication- and education interventions for woman with gestational diabetes. The five systematic reviews had a broad question and did not specifically deal with communication. The reviews were published between 2016 and 2018.
We included seven primary studies, two RCTs, three controlled studies and two studies without a control group. The studies investigated the effect of various educational interventions with elements such as diet, physical activity, glucose measurement and self-management. The studies were conducted mostly in hospital settings in the USA, Canada, Italy and Ireland.
We included one systematic review of qualitative studies and 12 primary studies about experiences with communication and educational interventions.
Four studies examined the health professionals' experience of providing information (midwife, diabetes nurse and gynecologist), seven studies investigated women’s experiences. One study described the communication between midwife and women with GDM. This study was conducted in Norway. Five of the studies about women’s experiences used different types of interview as method while two studies used focus groups.
In this mapping review, we have used a systematic method to search, sort and describe relevant literature about the effect and experience with communication and education interventions for women with gestational diabetes. The mapping review shows some of the diversity, volume and characteristic of available research, although we don´t report results which is not in the scope of our mandate.
A mapping review could be a starting point for considering which questions are considerable for systematics reviews and which question may lead to “empty” reviews. Mapping reviews can also be useful when considering and/or founding new research.
We found few studies about effect of communication- and educational interventions for woman with gestation diabetes; none of the studies was conducted in Norway. We found several studies about health personnel and pregnant women´s experience and some of them were conducted in Norway and Sweden.