title: A qualitative study of perceived barriers to management of diabetes among women with a history of diabetes during pregnancy.
abstract: BACKGROUND
  Uncontrolled diabetes during pregnancy can cause adverse maternal and infant outcomes. This study explored barriers to glycemic control before, during, and after pregnancy and describes knowledge, attitudes, and behaviors among pregnant women with pregestational diabetes (PGDM) or gestational diabetes (GDM).
  
  
  METHODS
  Focus groups were conducted in the Atlanta area among white, black, and Hispanic women who had diabetes during a recent pregnancy. Participants were a convenience sample drawn from a variety of sources. Nine focus groups were held with women who had GDM, and seven focus groups were held with women who had PGDM.
  
  
  RESULTS
  Participants identified five main areas of barriers to management of diabetes during pregnancy: financial barriers and difficulties accessing care, barriers to maintaining a healthy diet and exercising, communication difficulties, lack of social support, and barriers related to diabetes care. Participants with GDM had general awareness of possible diabetes complications but frequently could not name specific effects of diabetes on the woman or child during and after pregnancy. Most were unaware of their risk for developing type 2 diabetes later. Participants with PGDM expressed concern about the increased risk of adverse outcomes for the baby; most knew the importance of maintaining glycemic control during pregnancy. Low rates of pregnancy planning were reported in both groups. Pregnancy planning was not identified as a strategy to ensure a healthy baby.
  
  
  CONCLUSIONS
  The barriers to achieving glycemic control during pregnancy identified in this study could help inform future efforts to assist women in achieving optimal prepregnancy and intrapregnancy glycemic control.
authors: Atlanta Research and Education Foundation contractor for Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Atlanta, Georgia 30333, USA.
authors: Sarah A
authors: SA
authors: Collier
authors: Celene
authors: C
authors: Mulholland
authors: Jennifer
authors: J
authors: Williams
authors: Patricia
authors: P
authors: Mersereau
authors: Khadija
authors: K
authors: Turay
authors: Christine
authors: C
authors: Prue
mesh_terms: D022126:Access to Information; D003142:Communication; D016640:Diabetes, Gestational / Q000453:epidemiology* / Q000628:therapy; D004032:Diet; D015444:Exercise; D005260:Female; D017144:Focus Groups; D005845:Georgia; D006266:Health Education; D005102:Health Expenditures; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D010817:Physician-Patient Relations; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000453:epidemiology* / Q000628:therapy; D011295:Prenatal Care; D044469:Racial Groups; D012494:Sampling Studies; D012944:Social Support