Background Women with pre-existing Type 1 and Type 2 diabetes are around four times more likely to experience baby loss: miscarriage, stillbirth, neonatal death or termination of pregnancy for medical reasons. Careful pre-pregnancy preparation can reduce the risk of loss. However, pre-pregnancy information does not talk about the challenges of becoming pregnant again after a baby has died, and uptake of pre-pregnancy care is low. Approximately 50% of women with diabetes do not prepare for pregnancy - even after baby loss. There is a gap in understanding of how postnatal bereavement support should consider the context of diabetes and link with pre-pregnancy support for a subsequent pregnancy.
Aim To explore and better understand: (i) what it was like for women with diabetes to become pregnant again after baby loss; (ii) healthcare professional perspectives of providing pre-pregnancy care to this group.
Key Objective Develop recommendations for good practice to improve the support provided after a baby loss and improve preparation for future pregnancies among women with diabetes.
Methods Health professionals and women with diabetes were recruited for an interview through social media and professional networks. Recruitment is ongoing, with an anticipated sample size of 15–20 participants per group. Semi-structured interviews were used to gain in-depth experiential insights from both patient and healthcare perspectives. Interview transcripts were systematically analysed and synthesised using Thematic Analysis. Data collection and analyses are ongoing.
Results Early findings suggest individual needs differ depending on the type of diabetes and the type of loss. The influence of physical and social environments, such as living and working conditions, education level, employment status and access to transport, impact both the accessibility of care and the level of agency women with diabetes have to make the required lifestyle changes to prepare for pregnancy. Easy access to timely pre-pregnancy support from a multidisciplinary team and a sensitive discussion of pregnancy plans could reduce the risk of loss in a subsequent pregnancy. It is unclear who is responsible for supporting women in the interval between baby loss and subsequent pregnancy, and care varies across providers. Primary, community and secondary care all play a role in ensuring women with diabetes can access the care they need.
Conclusion These preliminary findings shine a new light on the challenges of becoming pregnant after a baby loss and the health service requirements for this group. Further interviews and analysis will help inform care development for women with diabetes and develop social science understanding of baby loss more generally.
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