The pregnancy journey for women with type 1 diabetes: a qualitative model from contemplation to motherhood

The purpose of this study is to describe and develop a model of the pregnancy journey for women with type 1 diabetes. We undertook a thematic analysis of written interactions (n=200; n=2060 text excerpts) with an online counselling support service from 93 women with type 1 diabetes. Seven possible discrete phases in the pregnancy journey were revealed: Contemplation, Pregnancy planning, Conception, Pregnancy, Delivery/birth, and Motherhood or Pregnancy loss. Eight common themes were identified, varying in importance across phases. Diabetes-specific distress was most evident during Contemplation and Motherhood. During pregnancy, social identity and peer support were paramount. Negative emotions in Pregnancy, while connected to diabetes, also centred on the unborn baby. In Motherhood, diabetes-specific distress and depressed mood increased. Medicalisation was expected and offered reassurance during Pregnancy; however, some women still worried, with peer support offering the most reassurance. In conclusion, women with type 1 diabetes potentially experience seven distinct phases of the pregnancy journey, with eight themes varying in significance across phases. Contemplation begins well before Planning or Conception, and women may seek support from non-mainstream sources. Mental health and emotional well-being varies qualitatively and quantitatively across phases (focusing on pregnancy-related distress, diabetes-specific distress and general maternal well-being), indicating a need for targeted assessment and support across the pregnancy journey. Copyright (C) 2016 John Wiley & Sons.