Becoming pregnant after a baby loss: improving inter-pregnancy care for women with type 1 and type 2 diabetes - a qualitative exploration of women’s experiences and healthcare professionals’ perspectives.

Abstract

Women with diabetes (WWD) are four times more likely to experience baby loss: miscarriage, stillbirth, neonatal death, or termination of pregnancy for medical reasons. Preparing for pregnancy reduces risks. However, only 50% of women with diabetes seek healthcare support to prepare for pregnancy, even after baby loss. Women may feel an overwhelming urge to become pregnant again as soon as possible after baby loss. The inter-pregnancy interval, the time between the baby loss and the start of a subsequent pregnancy, for women with diabetes averages 12 months, highlighting a small window of opportunity to support women with diabetes to both grieve and prepare for subsequent pregnancy. This qualitative research explored WWDs’ experiences and healthcare professional (HCP) perspectives using semi-structured interview data from 30 participants (WWD= 12; HCP= 18) from the UK and Ireland. Data were analysed using Reflexive Thematic Analysis. Three levels of analysis were conducted: 1) descriptive themes that captured the barriers faced in the inter-pregnancy interval; 2) explanatory themes, where theory (liminality, biomedicalisation, and neoliberal strategies of responsibilisation) was used to interpret the data further; 3) synthesis of themes using a stigma syndemic framework to shed light on the tensions between experiencing a baby loss, living with diabetes and preparing for a subsequent pregnancy. The findings connect areas of research seldom explored together, providing new insights into potential reasons why WWD do not ‘optimally prepare’ for pregnancy after experiencing a baby loss. I argue that WWD are disproportionately affected by various stigmas in the inter-pregnancy interval, which, when experienced simultaneously, have a synergistically negative effect. The stigmatising self-recrimination that WWD may feel at the intersection of baby loss and diabetes poses a particular challenge. The existing support available in the inter-pregnancy interval is inadequate to help WWD prepare for subsequent pregnancy after baby loss, as there is too much focus on individualistic factors and solutions to manage.