Healthcare Professionals’ Perspectives on the Cross-sectoral Treatment Pathway for Women with Gestational Diabetes During and After Pregnancy – A Qualitative Study

Abstract Background: Gestational diabetes increases the risk of complications during and after pregnancy, including a long-term risk of type 2 diabetes. Women with gestational diabetes have to navigate a complex treatment pathway during pregnancy, which they often experience as incoherent. These women also report a lack of preventive care after pregnancy. The objective of this study is to investigate healthcare professionals’ views on the cross-sectoral treatment pathway for women with gestational diabetes – under and after pregnancy. Methods: Nine healthcare professionals handling women with gestational diabetes before and after pregnancy in Denmark were interviewed (two general practitioners, four midwives, two obstetricians and one diabetes nurse). Further, eight health visitors participated in focus group discussions. The data material was analysed using systematic text condensation. Results: Three major themes emerged: 1) professional identity which varied across the healthcare professionals and consequently shaped care practices; 2) lack of priority in the area of gestational diabetes contributed to uncertainty of tasks and responsibilities across the treatment pathway; and 3) cross-sectoral collaboration relied heavily on knowledge transfer between hospitals, general practitioners, and the local municipality. Conclusion: Knowledge transfer was fragmented as guidelines for treatment in the postpartum period were unclear to healthcare professionals outside the hospital. More awareness should be given to structures that ease clear and transparent guidelines and tailored communication strategies for healthcare professionals who provide care to women with gestational diabetes under and after pregnancy.