The relationship of diabetes knowledge to regimen compliance and metabolic control during pregnancy

Abstract

The relationship of diabetes knowledge to regimen compliance and metabolic control was examined in a sample of pregnant women with preexisting insulin-dependent and noninsulin-dependent diabetes mellitus (N = 27) and women who developed gestational diabetes during pregnancy (N = 45). Subjects completed self-report measures of diabetes knowledge and compliance with their diabetic regimen and blood glucose levels were monitored. Knowledge was positively, although modestly, related to dietary compliance, compliance with insulin administration and insulin reaction management recommendations, as well as fasting blood glucose levels. Findings suggest that among pregnant women, efforts to increase knowledge of diabetes specific to pregnancy may result in some improvement in selected aspects of the diabetic regimen.     

The journey of gestational surrogacy: religion,spirituality and assisted reproductive technologies

This article discusses the intersection of women’s experiences with the assisted reproductive technological practice of gestational surrogacy and spirituality and religion. During the interviews of eight gestational surrogates themes of spirituality-, religion- and faith-based language emerged as these women shared their narratives of assisted reproductive technologies in this Canadian study. Professionals supporting women before, during and after the experience of gestational surrogacy need to be mindful of the significance of spirituality and religion in third party reproduction practices for many women. In discussing these topics with gestational surrogates counsellors, child and youth care practitioners, faith leaders, social workers, and educators need to remain open and attentive to a multiplicity of diverse theological negotiations.     

Maternal adjustment and infant outcome in medically defined high-risk pregnancy.

Biological and psychosocial risk factors in high-risk pregnancy and their relation to infant developmental outcomes were explored in a sample of 153 pregnant Israeli women who had pregestational diabetes mellitus, gestational diabetes mellitus, or were nondiabetic. Questionnaires on coping and resources as well as well-being and distress during the 2nd trimester were administered. Estimates of maternal fuels (HbAlc and fructosamine) were obtained throughout pregnancy. At 1 year, offspring were administered the Bayley Scales of Infant Development and mother-infant interactions were observed. Infants of mothers in the diabetic groups scored lower on the Bayley Scales and revealed fewer positive and more negative behaviors than did infants of mothers in the nondiabetic group. Infant outcomes in the maternal diabetic groups were associated with maternal metabolism. Maternal coping and resources differed in the 3 groups and differentially predicted infant development.     

Relationship beliefs and illness appraisals are differentially associated with specific ways of coping in spouses of patients with type 2 diabetes

Using data from 117 spouses of patients diagnosed with type 2 diabetes and multiple-group path analysis, the current study explored the association of four relationship beliefs (satisfaction, sacrifice, confidence and instability) and four diabetes appraisals (consequences, distress, control and efficacy) with illness-specific coping behaviour: active engagement, protective buffering and overprotection. The potential moderating effect of gender was also tested. Results indicated gender did moderate the associations among the variables in the model, with the association of relationship satisfaction and active engagement being significantly stronger for men, while diabetes control was more strongly related to protective buffering for women. The only variables associated with active engagement were three relationship-specific cognitions: higher levels of relationship satisfaction (for men only), satisfaction with sacrifice and relationship confidence were all related to higher active engagement. The diabetes appraisals were the only variables associated with protective buffering and overprotection. Higher diabetes distress and diabetes control (for women only) and lower diabetes efficacy were predictive of greater protective buffering. Lower diabetes efficacy and higher diabetes control were associated with greater overprotection. Implications for theory, research and practice are discussed.     

Psychological Distress and Associated Factors Among a Sample of Pregnant Women in South Africa

We sought to identify the prevalence of psychological distress and associated factors among pregnant women who were patients at antenatal primary care clinics in a South Africa district. A cross-sectional study using systematic sampling was conducted among 1497 pregnant women (age range=18 to 47 years; mean age=26.6 years, SD=6.1; Black African=98%), with a mean gestational age of 6.5 months (SD=1.6). They completed the Kessler Psychological Distress Scale, a measure of psychological distress. Results showed high rates of severe psychological distress (26.5%). Increased distress was in multivariate analysis associated with having had an STI (other than HIV), being unhappy about current pregnancy, and HIV positive. Identification of pregnant women with psychological distress in public health clinics is crucial for effective and appropriate targeted interventions.     

Intolerance to ambient odors at an early stage of pregnancy

Adverse reactions to ambient odorous and pungent substances in daily activities among pregnant women who are half-way through pregnancy, and changes in odor perception at predominantly an early stage of pregnancy motivated the present study of odor intolerance at an early pregnancy stage. Ninety-five women averaging gestational week 11 and 102 non-pregnant women were compared with the Chemical Sensitivity Scale for Sensory Hyperreactivity (CSS-SHR). General environmental intolerance was assessed with items from the Noise Sensitivity Scale that are analogous to the CSS-SHR ("NSS-SHR"). Pregnant women were found to have higher scores on the CSS-SHR, but not on the "NSS-SHR". This suggests an odor intolerance that affects pregnant women's daily activities, which appears not to be due to a general environmental intolerance. The effect size of pregnancy on CSS-SHR score is larger in the present study of early pregnancy than in the previous study of women half-way through pregnancy.     

Assessment of coping strategies, social support, and general health status in individuals with diabetes mellitus

This study examined 51 individuals (30 men, 21 women) who participated in an outpatient diabetes education program. Participants with higher perceived support by friends and problem-solving coping strategies were healthier, while those exhibiting a wish-fulfillment coping style were less healthy. Perceived family social support was much greater for Type II (noninsulin-dependent) individuals than for Type I (insulin-dependent) individuals. Men perceived greater family support, were more likely to use problem-solving coping, and were healthier than women; however, both wish fulfillment and detachment coping were more prevalent in women. Perceived support from family and friends increased with education. Implications for diabetes education programs are also introduced.     

Pre- and Postpartum Fear of Childbirth in Nulliparous and Parous Women

The link between fear of childbirth and theories of anxiety in general is discussed. A possible expression of trait (T-fear) and state (S-fear) aspects of fear of childbirth was investigated in 77 nulliparous and 85 parous women based on data from gestational week 32, at 2 hours and at 5 weeks after childbirth. Data are based on the State Trait Anxiety Inventory and the Wijma Delivery Expectancy/Experience Questionnaire. According to their scores on the Wijma Delivery Expectancy/Experience Questionnaire during late pregnancy, women were divided into 3 groups: high, moderate and low levels of fear of childbirth. In gestational week 32, women in the low level of fear of childbirth group had lower trait anxiety than those in the moderate level of fear of childbirth group, who had lower trait anxiety than the women in the high level of fear of childbirth group. Nulliparous women had a higher level of fear of childbirth but a lower level of trait anxiety than did parous women. There was a significant decreasing trend in fear of childbirth from 2 hours to 5 weeks after delivery, in a parallel way for all 3 groups. Differences in fear of childbirth between nulliparous and parous women disappeared after delivery. These findings suggest that fear of childbirth comprises a considerable part of T-fear, with the risk of a vicious cycle, i.e. that during labour women experience what they are afraid of, which also influences the women's postpartum cognitive appraisal of the delivery.     

Depression and Anxiety in Older and Middle‐aged Adults With Diabetes

This study aims to compare rates of depressive and anxious symptoms among older adults with and without diabetes. The study also examines differences in depression, anxiety, and diabetes‐related emotional distress between middle‐aged and older adults with diabetes. A total of 224 participants completed a range of questionnaires measuring depression, anxiety, and diabetes‐related emotional distress (if applicable). One hundred and three adults with diabetes (55 middle‐aged, mean age = 47 years, range 40–59 years and 48 older, mean age = 69 years, range 60–81 years) were recruited from a tertiary diabetes clinic. One hundred and twenty‐one adults without diabetes (72 middle‐aged, mean age = 52 years, range 40–59 years and 49 older, mean age = 65 years, range 60–76 years) were recruited from either a university student pool or a registry of adults aged 50 and above. Older adults with diabetes had significantly higher levels of depression and comparable levels of anxiety with older adults without diabetes. Older adults with diabetes had significantly lower levels of depression, anxiety, and diabetes‐related distress than middle‐aged adults with diabetes. Diabetes is associated with high rates of depression and anxiety, with middle‐aged adults more adversely affected than older adults.     

Prenatal dopamine and neonatal behavior and biochemistry

Depressed pregnant women (N=126) were divided into high and low prenatal maternal dopamine (HVA) groups based on a tertile split on their dopamine levels at 20 weeks gestation. The high versus the low dopamine group had lower Center for Epidemiological Studies-Depression Scale (CES-D) scores, higher norepinephrine levels at the 20-week gestational age visit and higher dopamine and serotonin levels at both the 20- and the 32-week gestational age visits. The neonates of the mothers with high versus low prenatal dopamine levels also had higher dopamine and serotonin levels as well as lower cortisol levels. Finally, the neonates in the high dopamine group had better autonomic stability and excitability scores on the Brazelton Neonatal Behavior Assessment Scale. Thus, prenatal maternal dopamine levels appear to be negatively related to prenatal depression scores and positively related to neonatal dopamine and behavioral regulation, although these effects are confounded by elevated serotonin levels.     

Depressive symptomatology during pregnancy: evidence for an association with decreased fetal growth in pregnancies of lower social class women.

The relationship between depressive symptom scores on the Center for Epidemiological Studies Depression Scale (CES-D; L. S. Radloff, 1977) at each trimester of pregnancy and a decrement in either fetal growth or gestational duration was evaluated among 666 pregnant women. There was no association overall, but among 222 women from lower occupational status households, each unit increase on the CES-D at 28 weeks gestation was associated with a reduction of 9.1 g (95% confidence interval [CI] = -16.0, -2.3) in gestational-age-adjusted birth weight. When missing data were multiply imputed, the estimate was -4.6 g (95% CI = - 10.7, 1.5). CES-D score was unrelated to fetal growth or gestational duration in analyses among other potentially high-risk subgroups: smokers, women with a history of adverse outcome, and women with social vulnerabilities. These results raise the possibility that among lower status women, depressive mood may be associated with restricted fetal growth.     

Anxiety in Kuwaiti and American college students

Samples of Kuwaiti (n=646) and American (n=320) undergraduates responded to the Kuwait University Anxiety Scale in Arabic and English, respectively. Differences by sex were significant, with women having a higher mean anxiety score than men and by country with Kuwaiti women having a higher anxiety score than American women.     

Anxiety and chronic couple relationship stress moderate adrenocortical response to couple interaction in expectant parents

The study examines whether anxiety or chronic relationship stress alter the way that couple conflict affects cortisol levels for women and men during the transition to parenthood. Saliva samples, assayed for cortisol, were collected before and after couple interaction from 128 heterosexual couples expecting their first child. Confirming prior research, expectant mothers had higher cortisol levels than their spouses, and gestational age was linked to women's cortisol level. Negativity during couple interaction was associated with greater cortisol reactivity for men, but not women. Tests of moderation indicated little relation between negativity and cortisol recovery for individuals with a low level of anxiety or little history of chronic arguing with the partner. However, among individuals with elevated levels of either of these two factors, negativity was linked to less cortisol recovery for men, but more cortisol recovery for women. Consistent results were also found for the relation between low warmth in the couple interaction and both reactivity and recovery for men and women high in anxiety. Future research should examine whether pregnancy is responsible for these different gender patterns, or whether the inhibition of negativity is stressful for women with high levels of risk.     

Prenatal cortisol, prematurity and low birthweight

Three hundred depressed pregnant women were recruited at approximately 20 weeks gestation. They were then divided by a median split into high and low urinary cortisol level groups. The high cortisol group had higher CES-D depression scores and higher inhibition (BIS) scores prenatally. Their fetuses had smaller head circumference, abdominal circumference, biparietal diameter and fetal weight. The high cortisol group neonates were shorter gestational age and lower birthweight and they had lower Brazelton habituation and higher Brazelton reflex scores. Discriminant function analyses suggested that cortisol levels more accurately classified short gestation and low birthweight groups than CES-D depression scores.     

Gender,Emotional Support,and Well-Being Among the Rural Elderly

The current study sought to clarify the effects of social support on the psychological well-being of rural elders. Data were provided by 180 older men and women (mean age = 73.6 years) living in Northern Appalachia. Similar to the demographic profile of this region, most (97.2%) of the participants were Caucasian. Although mean differences in perceptions of emotional support did not emerge, the relative importance of various sources of support differed for men and women. For men, higher satisfaction with family support was associated with lower negative affect and higher positive affect. For women, although satisfaction with emotional support from family and more years of education were associated with lower levels of negative affect, emotional support from friends enhanced positive affect. The results suggest that new programs may be needed in order to help older rural men and women to maintain well-being in late life.     

Rorschach variables related to blood glucose control in insulin-dependent diabetes patients

In this article, we explored relations between selected Rorschach variables and blood glucose control in Insulin-Dependent Diabetes Mellitus (IDDM) patients. Three domains of psychological functioning are taken into consideration: emotional distress, coping and problem solving, and cognitive efficiency. Seventy-one IDDM patients (38 men, 33 women; mean age 42.2 +/- 14.9 years) from an outpatient unit took the Rorschach Comprehensive System (Exner, 1986). Nine variables were selected as independent variables. Blood glucose, a dependent variable, was measured by the proportion of glycated hemoglobin. Results of 2 regression analyses show that Y and C' correlate to higher blood glucose. WSum C and the absence of texture related to lower levels of blood glucose. A confounding effect of complications was observed. The findings suggest that emotional factors should be accorded greater attention in behavioral self-regulations in diabetes.     

Commercial Contract Pregnancy in India,Judgment, and Resistance to Oppression

Feminist scholars have done much to identify oppressive forces within transnational commercial contract pregnancy and its social context that may coerce women into becoming gestational laborers. Feminists have also been careful not to depict gestational laborers as merely passive victims of oppression, though there is disagreement about the degree to which contract pregnancy offers opportunities for agency. In this article I consider how women who sell gestational labor may be agents against their oppression. I make explicit connections between resistance and judgment, which I will take to be a critically considered, intersubjective evaluative claim. Drawing on work by Jennifer Nedelsky and Hannah Arendt, my main argument will be that individual judgments can better enable oppressed persons to resist some aspects of their oppression, and that judgment helps to (further) develop agential capacities, in particular, the capacity for a person to be self‐constituting, to see herself as giving reasons for her own actions. I use Indian contract pregnancy as a case study to think through connections between resistance and judgment.     

暴发性1型糖尿病：一种不可忽视的重症糖尿病

暴发性1型糖尿病以起病急骤、代谢紊乱严重、胰酶升高并缺乏糖尿病相关抗体为特征。本文回顾分析我院收治的3例暴发性l型糖尿病的临床资料并结合文献与经典1型糖尿病进行对比复习,以提高对该病的认识。3例患者平均病程5．3天,入院平均血糖27．8mmol／L,平均糖化血红蛋白（HbAlC）6．8％,平均空腹C肽0．043ng／ml,平均餐后2hC肽0．04ng／ml,平均胰岛素使用剂量0．50U／（kg·d）。随访6个月HbAlC平均值为7．5％,胰岛8细胞功能无改善。暴发性1型糖尿病较经典1型糖尿病有更严重的胰岛素缺乏、代谢紊乱,更强烈的免疫反应,预后较差。     

Treating Prepartum Depression to Improve Infant Developmental Outcomes: A Study of Diabetes in Pregnancy

Whether and how the co-occurrence of depression and diabetes in pregnancy may worsen infant development has not been reported. Pregnant women with diabetes and with (n?=?34) or without (n?=?34) major depressive disorder (MDD) were followed during pregnancy and 6-months postpartum. The MDD subset received randomly assigned treatment with cognitive behavior therapy (CBT) or supportive counseling (SC). Depression severity was measured with the Beck Depression Inventory (BDI); infant developmental outcomes were measured with the Bayley Scales of Infant Development (BSID) and its Behavior Rating Scale (BRS). Infants of women with MDD had lower BRS scores (p?=?.02). Reduction in depression scores was associated with better infant outcomes on the BSID and BRS (p values <.03). These preliminary findings suggest depression occurring in pregnant women with diabetes is associated with poorer infant development and improvement in prepartum depression is associated with improvement in measures of infant development.     

FACTORS ASSOCIATED WITH ACCULTURATIVE STRESS AND DEPRESSIVE SYMPTOMATOLOGY AMONG MARRIED MEXICAN IMMIGRANT WOMEN

The purpose of the present study was to describe levels of acculturative stress and individual stressors and their relationship to levels of depressive symptomatology among young Mexican immigrant women. The mean age of the respondents was 25.7 years with a mean of 9.4 years of education. Their age at migration was 18.5 years and their average length of stay in the United States was 7.5 years. Women who in the last three months experienced discrimination, sex-role conflicts, and concern about starting a family in this country had significantly higher (over 16) CES-D scores than women who did not report experiencing those situations. The overall findings suggest that this sample of Mexican women immigrants as a group are at risk for the development of psychological problems.