Quality of Life Research

, Volume 21, Issue 2, pp 291–298

Quality of life in pregnancy and post-partum: a study in diabetic patients

  • M. G. Dalfrà
  • A. Nicolucci
  • T. Bisson
  • B. Bonsembiante
  • A. Lapolla
Article

Abstract

Purpose

We evaluated quality of life in pregnant women with diabetes followed up at Italian diabetes clinics.

Methods

A total of 245 pregnant women (30 type 1 diabetes mellitus (T1DM), 176 gestational diabetes (GDM) and 39 controls) were asked to fill in a questionnaire including the SF-36 Health Survey and the Center for Epidemiological Studies-Depression (CES-D) Scale in third trimester of pregnancy and after delivery. GDM and T1DM also completed two diabetes-specific questionnaires (Diabetes-related stress and Diabetes health distress). Quality of life scores were compared between the groups with the Mann–Whitney U-test, mean changes in scores (after delivery to 3rd trimester) were compared between groups by ANCOVA.

Results

Regarding the SF-36 scores in the third trimester of pregnancy, T1DM and GDM women had a better Standardised Physical Component score than controls (P < 0.0001, P = 0.009, respectively). GDM and T1DM pregnant women scored significantly lower for general health perception than controls (P = 0.009 and P = 0.001, respectively). T1DM patients had lower Standardised Mental Component scores than controls (P = 0.03). Compared with the third trimester of pregnancy, the severity of depressive symptoms increased significantly after delivery in both diabetic groups, but not in controls (P < 0.0001). Scores improved in all SF-36 areas in healthy and GDM women, while they all became worse in the T1DM group.

Conclusions

Pregnancy is associated with a perception of poor general health in women with both T1DM and GDM. After delivery, significantly worse depressive symptoms were documented in both groups, while a generally worse physical and psychological well-being was only identified in women with T1DM. These findings have important implications for pregnancy follow-up.

Keywords

Quality of life Pregnancy Gestational diabetes Type 1 diabetes mellitus Insulin therapy 

References

  1. 1.
    Kamysheva, E., Skouteris, H., Wetrheim, E. H., Paxton, S. J., & Milgrom, J. (2008). Examination of a multifactorial model of body-related experiences during pregnancy: The relationships among physical symptoms, sleep quality, depression, self-esteem, and negative body attitudes. Body Immage, 5(2), 152–163.CrossRefGoogle Scholar
  2. 2.
    Lacasse, A., Rey, E., Ferreira, E., Morin, C., & Berard, A. (2008). Nausea and vomiting of pregnancy: What about quality of life? BJOG, 115, 1484–1493.PubMedCrossRefGoogle Scholar
  3. 3.
    Horwitz, S. M., Briggs-Cowan, M. J., Storfer-Isser, A., & Carter, A. S. (2007). Prevalence, correlates, and persistence of maternal depression. Journal of Women Health, 16(5), 678–691.CrossRefGoogle Scholar
  4. 4.
    Chida, Y., & Hamer, M. (2008). An association of adverse psychosocial factors with diabetes mellitus. A meta-analytic review of longitudinal cohort studies. Diabetologia, 51, 2168–2178.PubMedCrossRefGoogle Scholar
  5. 5.
    Bradley, C., & Speight, J. (2002). Patient perception of diabetes and diabetes therapy: Assessing quality of life. Diabetes Metabolism Research and Reviews, 10, S64–S69.CrossRefGoogle Scholar
  6. 6.
    Langer, N., & Langer, O. (1994). Emotional adjustment to diagnosis and intensified treatment of gestational diabetes. Obstetrics and Gynecology, 84, 329–334.PubMedGoogle Scholar
  7. 7.
    Spirito, A., Williams, C., Ruggiero, L., Bond, A., MvcGarvey, S. T., & Coustan, D. (1989). Psychological impact of the diagnosis of gestational diabetes. Obstetrics and Gynecology, 73(4), 562–566.PubMedGoogle Scholar
  8. 8.
    Langer, N., & Langer, O. (2000). Comparison of pregnancy mood profiles in gestational diabetes and preexisting diabetes. The Diabetes Educator, 26, 667–672.PubMedCrossRefGoogle Scholar
  9. 9.
    Kim, C., Brawarsky, P., Jackson, R. A., Fuentes-Affick, E., & Haas, J. S. (2005). Changes in health status experienced by women with gestational diabetes and pregnancy-induced hypertensive disorders. Journal of Womens Health, 14, 729–736.CrossRefGoogle Scholar
  10. 10.
    Halkoaho, A., Kavilo, M., Pietila, A.-M., Huopio, H., Sintonen, H., & Heinonen, S. (2010). Does gestational diabetes affect women’s health-related quality of life after delivery? European Journal of Obstetrics Gynecology Reproductive Biology, 148, 40–43.CrossRefGoogle Scholar
  11. 11.
    Carpenter, M. W., & Coustan, D. R. (1982). Criteria for screening tests for gestational diabetes. Journal of Obstetrics Gynecology, 144, 768–773.Google Scholar
  12. 12.
    Metzger, B. E., Buchanan, T. A., & Coustan, D. R., et al. (2007). Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes Care, 30(2), S251–S260.Google Scholar
  13. 13.
    American Diabetes Association. (2004). Preconception care of women with diabetes in pregnancy. Diabetes Care, 27(Suppl 1), S76–S78.Google Scholar
  14. 14.
    Greenfield, S., Kaplan, S. H., Silliman, R. A., Sullivan, L., Manning, W., D’Agostino, R., et al. (1994). The uses of outcomes research for medical effectiveness, quality of care, and reimbursement in type 2 diabetes. Diabetes Care, 17(suppl. 1), 32–39.PubMedGoogle Scholar
  15. 15.
    Apolone, G., & Mosconi, P. (1998). The Italian SF-36 health survey: Translation, validation and norming. Journal of Clinical Epidemiology, 51, 1025–1036.PubMedCrossRefGoogle Scholar
  16. 16.
    Franciosi, M., Pellegrini, F., De Berardis, G., Belfiglio, M., Cavaliere, D., & Di Nardo, B., et al. (2001) The QuED Study group—quality of care and outcomes in type 2 diabetes. The impact of blood glucose self-monitoring on metabolic control and quality of life in type 2 diabetic patients. An urgent need for better educational strategies. Diabetes Care, 24, 1870–1877.Google Scholar
  17. 17.
    De Berardis, G., Franciosi, M., Belfiglio, M., Di Nardo, B., Greenfield, S., & Kaplan, S. H., et al. (2002) Quality of care and outcomes in type 2 diabetes (QuED) study group. (2002). Erectile dysfunction and quality of life in type 2 diabetes (QuED) study group. (2002). Erectile dysfunction and quality of life in type 2 diabetic patients: a serious problem too often overlooked. Diabetes Care, 25, 284–291.Google Scholar
  18. 18.
    Ware, J., Snow, K., Kosinski, M., & Gandek, B. (1993). SF-36 health survey: Manual and interpretation guide. Boston, MA: New England Medical Center Health Institute.Google Scholar
  19. 19.
    Ware, J. E., Kosinski, M., & Keller, S. D. (1994). SF-36 physical and mental health summary scales: A user’s manual. Boston, MA: The Health institute, New England Medical Center.Google Scholar
  20. 20.
    Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  21. 21.
    Comstock, G. W., & Helsing, K. J. (1976). Symptoms of depression in two communities. Psychological Medicine, 6, 551–563.PubMedCrossRefGoogle Scholar
  22. 22.
    Dunn, S. M., Smartt, H. H., Beeney, L. J., & Turtle, J. R. (1986). Measurement of emotional adjustment in diabetic patients: validity and reliability of ATT39. Diabetes Care, 9, 480–489.PubMedCrossRefGoogle Scholar
  23. 23.
    Rumbold, A. R., & Crowther, C. A. (2002). Women’s experiences of being screened for gestational diabetes mellitus. The Australian & New Zealand Journal of Obstetrics & Gynaecology, 42, 131–137.CrossRefGoogle Scholar
  24. 24.
    Kim, C., Newton, K. M., & Knopp, R. H. (2002). Gestational diabetes and the incidence of type 2 diabetes. Diabetes Care, 25, 1862–1868.PubMedCrossRefGoogle Scholar
  25. 25.
    Mezuk, B., Eaton, W., Albrecht, S., & Golden, S. H. (2008). Depression and type 2 diabetes over the lifespan. Diabetes Care, 31, 2383–2390.PubMedCrossRefGoogle Scholar
  26. 26.
    Samsa, G., Edelman, D., Rothman, M. L., Williams, G. R., Lipscomb, J., & Matchar, D. (1999). Determining clinically important differences in health status measures: A general approach with illustration to the health utilities index mark II. Pharmacoeconomics, 15, 141–155.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • M. G. Dalfrà
    • 1
  • A. Nicolucci
    • 2
  • T. Bisson
    • 1
  • B. Bonsembiante
    • 1
  • A. Lapolla
    • 1
  1. 1.DPT Scienze Mediche e ChirurgicheUniversità di PadovaPadovaItaly
  2. 2.DPT Farmacologia Clinica ed EpidemiologiaConsorzio Mario Negri SudS. Maria Imbaro, ChietiItaly

Personalised recommendations