Background

Medical nutrition therapy is recognised as the cornerstone to optimal glycaemic management of gestational diabetes (GDM) during pregnancy and the dietitian is central to delivery of this, yet data are lacking on their views of the barriers and enablers to performing this role.

Objective

This qualitative study aimed to explore the perspectives of registered dietitians providing medical nutrition therapy (MNT) to people with GDM across the Republic of Ireland.

Design

Focus groups and semi-structured interviews were conducted with dietitians from maternity settings, whose roles included providing dietetic services to people with GDM.

Participants and setting

Five focus groups and two semi-structured interviews were conducted with 16 dietitians from 13 maternity sites, whose roles included MNT to people with GDM, in Ireland in February-March 2021. A topic guide addressing GDM management, postpartum care, and future type 2 diabetes prevention was followed.

Data analysis

Data from focus groups and interviews were analyzed using reflexive thematic analysis.

Results

Dietitians collectively viewed their role as central to supporting people with GDM. Three themes were generated: Theme one ‘a complex layered role’ addressed complexities in dietetic practice. Theme two highlighted ‘challenges in providing optimum care’ with sub-themes of ‘huge changes with COVID-19’, ‘care is not equal’ and ‘no defined postpartum pathway’. Theme three reported on ‘framing future health needs’, through sub-themes of ‘the six-week check is a missed opportunity’, ‘people need to understand their risk’, and ‘more integrated care and type 2 diabetes prevention is needed’.

Conclusions

Dietitians recognise the need for continuity of care in pregnancy and postpartum for people diagnosed with GDM. However, perceived disparities in allocation of dietetic services for GDM and an absence of agreed care pathways were seen as barriers to optimum care. Collaboration and communication across primary and secondary care settings are essential and require improvement.

中文翻译：

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爱尔兰孕妇营养师对妊娠糖尿病护理和产后随访的看法：一项定性研究。

背景

医学营养治疗被认为是妊娠期糖尿病 (GDM) 最佳血糖管理的基石，营养师是实现这一目标的核心，但缺乏数据来说明他们对发挥这一作用的障碍和推动因素的看法。

客观的

这项定性研究旨在探讨向爱尔兰共和国各地 GDM 患者提供医学营养治疗 (MNT) 的注册营养师的观点。

设计

与来自产科机构的营养师进行了焦点小组和半结构化访谈，他们的职责包括为 GDM 患者提供饮食服务。

参加者及设置

2021 年 2 月至 3 月，在爱尔兰，对来自 13 个产科中心的 16 名营养师进行了五个焦点小组和两次半结构化访谈，他们的职责包括对 GDM 患者进行 MNT。主题指南涉及 GDM 管理、产后护理和未来 2 型糖尿病其次是糖尿病的预防。

数据分析

使用反思性主题分析来分析来自焦点小组和访谈的数据。

结果

营养师普遍认为他们的角色是支持 GDM 患者的核心。产生了三个主题：主题一“复杂的分层角色”解决了饮食实践中的复杂性。主题二强调“提供最佳护理的挑战”，副主题包括“COVID-19 带来的巨大变化”、“护理不平等”和“没有明确的产后途径”。主题三报告了“制定未来的健康需求”，通过“六周检查是一个错失的机会”、“人们需要了解自己的风险”和“需要更综合的护理和 2 型糖尿病预防”等子主题。

结论

营养师认识到诊断患有 GDM 的人在怀孕期间和产后需要持续护理。然而，GDM 饮食服务分配的明显差异以及缺乏商定的护理途径被视为最佳护理的障碍。初级和二级护理机构之间的合作和沟通至关重要，并且需要改进。