Women's and healthcare providers' perceptions of long-term complications associated with hypertension and diabetes in pregnancy: a qualitative study.
Nagraj S., Hinton L., Praveen D., Kennedy S., Norton R., Hirst J.
OBJECTIVES: A diagnosis of hypertensive disorders during pregnancy (HDPs) or gestational diabetes mellitus (GDM) is highly predictive of women at increased risk of developing chronic hypertension, Type 2 diabetes and cardiovascular disease. This study investigates perceptions of women and healthcare providers in rural India regarding these long-term risks. DESIGN: Qualitative study using modified grounded theory. SETTING: Two states in rural India: Haryana and Andhra Pradesh. POPULATION: Pregnant and postpartum women, community health workers (CHWs), primary care physicians, obstetricians, laboratory technicians, and healthcare officials. METHODS: In-depth interviews and focus group discussions explored: (i) priorities for high-risk pregnant women; (ii) detection and management of HDPs and GDM; (iii) postpartum management, and (iv) knowledge of long-term sequelae of high-risk conditions. A thematic analysis was undertaken. RESULTS: Seven focus group discussions and 11 in-depth interviews (n= 71 participants) were performed. The key priority area for high-risk pregnant women was anaemia. Blood pressure measurement was routinely embedded into antenatal care, however postpartum follow-up and knowledge the long-term complications was limited. GDM was not considered a common problem, although significant variations and challenges to GDM screening were identified. Knowledge of the long-term sequelae of GDM with regards to an increased risk of Type 2 diabetes and cardiovascular disease amongst doctors was minimal. CONCLUSIONS: There is a need for improved education, standardisation of testing and postpartum follow-up of HDPs and GDM in rural Indian settings. This article is protected by copyright. All rights reserved.