title: Psychosocial issues of women with type 1 diabetes transitioning to motherhood: a structured literature review.
abstract: BACKGROUND
  Life transitions often involve complex decisions, challenges and changes that affect diabetes management. Transition to motherhood is a major life event accompanied by increased risk that the pregnancy will lead to or accelerate existing diabetes-related complications, as well as risk of adverse pregnancy outcomes, all of which inevitably increase anxiety. The frequency of hyperglycaemia and hypoglycaemia often increases during pregnancy, which causes concern for the health and physical well-being of the mother and unborn child. This review aimed to examine the experiences of women with T1DM focusing on the pregnancy and postnatal phases of their transition to motherhood.
  
  
  METHODS
  The structured literature review comprised a comprehensive search strategy identifying primary studies published in English between 1990-2012. Standard literature databases were searched along with the contents of diabetes-specific journals. Reference lists of included studies were checked. Search terms included: 'diabetes', 'type 1', 'pregnancy', 'motherhood', 'transition', 'social support', 'quality of life' and 'psychological well-being'.
  
  
  RESULTS
  Of 112 abstracts returned, 62 articles were reviewed in full-text, and 16 met the inclusion criteria. There was a high level of diversity among these studies but three common key themes were identified. They related to physical (maternal and fetal) well-being, psychological well-being and social environment. The results were synthesized narratively.
  
  
  CONCLUSIONS
  Women with type 1 diabetes experience a variety of psychosocial issues in their transition to motherhood: increased levels of anxiety, diabetes-related distress, guilt, a sense of disconnectedness from health professionals, and a focus on medicalisation of pregnancy rather than the positive transition to motherhood. A trusting relationship with health professionals, sharing experiences with other women with diabetes, active social support, shared decision and responsibilities for diabetes management assisted the women to make a positive transition. Health professionals can promote a positive transition to motherhood by proactively supporting women with T1DM in informed decision-making, by facilitating communication within the healthcare team and co-ordinating care for women with type 1 diabetes transitioning to motherhood.
authors.affiliation: School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, Vic 3125, Australia. bodilr@deakin.edu.au.
authors.forename: Bodil
authors.initials: B
authors.lastname: Rasmussen
authors.forename: Christel
authors.initials: C
authors.lastname: Hendrieckx
authors.forename: Brydie
authors.initials: B
authors.lastname: Clarke
authors.forename: Mari
authors.initials: M
authors.lastname: Botti
authors.forename: Trisha
authors.initials: T
authors.lastname: Dunning
authors.forename: Alicia
authors.initials: A
authors.lastname: Jenkins
authors.forename: Jane
authors.initials: J
authors.lastname: Speight
mesh_terms: D001007:Anxiety / Q000523:psychology; D001786:Blood Glucose / Q000378:metabolism; D003863:Depression / Q000523:psychology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology*; D005260:Female; D006167:Guilt; D006801:Humans; D008016:Life Change Events; D009035:Mothers / Q000523:psychology*; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood / Q000523:psychology*; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology
chemical_list: D001786:Blood Glucose