Women's perspectives to improve prenatal care for gestational diabetes: A systematic review and meta-aggregation of qualitative studies

Abstract

Introduction

In numerous qualitative primary studies, women have identified opportunities to improve prenatal gestational diabetes care. The objective of our systematic review and meta-aggregation was to synthesize patient-guided suggestions for improving prenatal gestational diabetes care that are informed by lived experience of women and their support persons.

Material and Methods

This study was registered a priori on PROSPERO (CRD42023394014). Our search strategy was executed in five databases (Medline, PsycInfo, CINAHL, Scopus, and Web of Science). Primary studies that were qualitative, had full texts in English, studied women who have or had gestational diabetes or their support persons, and included experiential accounts on prenatal gestational diabetes care were included. No date restrictions were applied. Studies that were not qualitative, were secondary analyses, included data on only postpartum care, or evaluated an intervention that was not standard care were excluded. Two independent authors used Covidence software to facilitate screening. The outcomes of interest were patient-reported suggestions to improve quality of gestational diabetes care that are informed by women's or their support persons' accounts of the lived experience of gestational diabetes. Meta-aggregation followed by a thematic synthesis approach was used to analyze the qualitative data to identify women's perspectives to improve gestational diabetes care.

Results

After duplicate removal, a total of 4761 studies underwent screening and a total of 80 studies were ultimately included. Patient- and support persons-reported suggestions to improve care include timely and comprehensive education around gestational diabetes with active engagement of family members, personalized and tailored counseling, patient-centered care, incorporation of digital or online adjuncts to care, and increasing support for women.

Conclusions

Our systematic review and meta-aggregation identifies several actionable and patient-guided suggestions to improve prenatal gestational diabetes care that are important to consider when embarking on clinical quality improvement.