Diabetes in Pregnancy among First Nations Women in Alberta: A Multiphase Mixed Methods Approach

  • Author / Creator
    Oster, Richard, T.
  • Background Diabetes in pregnancy is thought to be an important driver of the current epidemic of type 2 diabetes in First Nations populations. Purpose The purpose of this doctoral research was 1) to generate an epidemiological profile of First Nations diabetes in pregnancy in Alberta; and 2) to qualitatively explore among First Nations women both the experience of having diabetes in pregnancy and the factors that contribute to achieving a healthy pregnancy. Methods De-identified provincial administrative data of delivery records was obtained for the years 2000-2009. Pregestational, past obstetrical, and delivery outcomes and problems were described and compared by ethnicity and diabetes status. Rates of gestational diabetes mellitus (GDM) and pregestational diabetes were compared by ethnicity, as were longitudinal changes over time. Diabetes in pregnancy predictors were explored via logistic regression. A focused ethnography was conducted with 12 First Nations women with previous diabetes in pregnancy who sought care in Edmonton. Unstructured interviews were carried out and were recorded, transcribed, and subject to qualitative content analysis. Results Quantitative: First Nations women were more likely to have antenatal risk factors and adverse infant outcomes, which were compounded by diabetes. Although GDM rates were higher among First Nations women, prevalence grew more rapidly over time in non-First Nations women. The longitudinal rates of pregestational diabetes were generally steady, yet First Nations women endure a greater than two-fold higher prevalence. Being of First Nations descent was an independent predictor of diabetes in pregnancy. Qualitative: The experience of diabetes in pregnancy is one wrought with difficulties but balanced to some degree by positive lifestyle changes. A struggle for control permeated the pregnancy experience, but having a strong support system (family, healthcare, cultural/community and internal) and the necessary resources (primarily awareness/education) allowed women to take some control of their health. Conclusions As high-risk pregnancies and poor outcomes are more common among First Nations women regardless of diabetes status, efforts must be made to improve pregnancy care. Specifically, these efforts should strive to enhance the support systems of these women, increase their sense of autonomy, and raise awareness of diabetes in pregnancy and its accompanying challenges.

  • Subjects / Keywords
  • Graduation date
  • Type of Item
  • Degree
    Doctor of Philosophy
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
  • Language
  • Institution
    University of Alberta
  • Degree level
  • Department
  • Specialization
    • Experimental Medicine
  • Supervisor / co-supervisor and their department(s)
  • Examining committee members and their departments
    • Mayan, Maria (Faculty of Extension)
    • King, Malcolm (Medicine)
    • Morrish, Donald (Medicine)
    • Sia, Winnie (Medicine)
    • Smylie, Janet (Dalla Lana School of Public Health, University of Toronto)