Academic journal article Care Management Journals

Perceptions and Concerns regarding Diabetes Mellitus during Pregnancy among American Indian Women

Academic journal article Care Management Journals

Perceptions and Concerns regarding Diabetes Mellitus during Pregnancy among American Indian Women

Article excerpt

Diabetes among American Indian (AI) people is a condition that creates excessive morbidity and mortality and is a significant health disparity. This research delineated culturally constructed models of diabetes mellitus (DM) among 97 pregnant women in 2 large AI Nations in Oklahoma. Analysis of data revealed intense anxiety, fear, and dread related to DM during pregnancy. The sample was stratified by DM status: (a) absence of DM (n = 66), (b) DM prior to pregnancy (n = 4), and (c) gestational (n = 27). Structured and semistructured interviews elicited patient culturally based explanatory models (EMs) of etiology, course, and treatment. The research incorporated an integrated phenomenologic and ethnographic approach and yielded both quantitative and qualitative data. General findings comprised the following main categories of patients' concerns regarding DM as an illness: (a) care-seeking behaviors, (b) medical management, (c) adherence and self-management, (d) complications, and (e) the conceptual sense of DM as a "severe" and feared condition. Many findings varied according to acculturation status, but all included significant fear and anxiety surrounding (a) the health and well-being of the unborn child, (b) the use of insulin injections, (c) blindness, (d) amputation, and (e) death, but with (f ) a paradoxically lowered anxiety level about diabetes severity overall, while at the same time expressing extreme dread of specific outcomes. The latter finding is considered consistent with the presence of chronic conditions that can usually be managed, yet still having risk if severe.

Keywords: diabetes; American Indian women; disease anxiety; pregnancy

According to the Indian Health Service, 16.3% of American Indians/Alaska Natives (AI/AN) have been diagnosed with diabetes mellitus (DM), and 30.0% of AI/AN have pre-DM. These data indicate that AI/AN are 2.2 times more likely to have DM than non-Hispanic Whites (Indian Health Service Division of Diabetes Treatment and Prevention, 2008). AI/AN with DM are four times more likely than their White counterparts to experience an amputation as a consequence of DM. They are six times more likely to experience kidney failure. In Oklahoma's 37 federally recognized tribes, 24% of AI peoples with DM experience diabetic retinopathy as a complication of their condition (American Diabetes Association, 2013; Roubideaux & Acton, 2001).

Regarding DM during pregnancy, the prevalence rate of gestational DM (GDM) is approximately 7% (Evert & Hei, 2006). Unfortunately, this rate has increased in recent years among both AI and White mothers. However, the prevalence of GDM in AI women continues to exceed that of the White population (Moum et al., 2004) but varies greatly across tribes. In some AI/ AN and Canada First Nations tribes, the prevalence rate may be as high as 15% (Raymer, 2006). Findings from Acton et al. (2002) regarding an analysis of data from 105 Indian Health Service Units identified a 46% increase in the DM prevalence rate in women of childbearing age for the period 1990-1996. This represents a notable public health concern. It also represents a significant health disparity which may have political/economic underpinnings.

Among all populations, DM during pregnancy is a major cause of congenital anomalies, malformations, shoulder dystocia, neonatal hypoglycemia, and perinatal death (Acton et al., 2002; Setji, Brown, & Feinglos, 2005). It places pregnant women at risk for hypertension, preeclampsia, premature birth, macrosomia, and an increased incidence of cesarean section (Kim, 2010; Setji et al., 2005). Research has also shown that offspring of mothers with DM are at an increased risk for obesity, abnormal glucose tolerance, and type 2 DM later in life (Acton et al., 2002; Kim, 2010; Moum et al., 2004). This increased risk is an important variable to be considered when examining the perpetuation of high DM prevalence in AI/AN tribes.

When women are identified as having GDM, the first line of treatment is medical nutrition therapy (MNT) with dietary control, physical activity, and regular glucose monitoring. …

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