Experiences of pregnant women diagnosed with gestational diabetes mellitus in the context of HIV/AIDS in the uGu District of KwaZulu-Natal Province. A qualitative study

Experiences of pregnant women diagnosed with gestational diabetes mellitus in the context of HIV/AIDS in the uGu District of KwaZulu-Natal Province. A qualitative study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Experiences of pregnant women diagnosed with gestational diabetes mellitus in the context of HIV/AIDS in the uGu District of KwaZulu-Natal Province. A qualitative study Zandile P. Nxumalo, Nokwanda E. Bam, Khumoetsile D. Shopo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8153814/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 14 You are reading this latest preprint version Abstract Background: Human immunodeficiency virus (HIV) is an intricate retrovirus that is chronic and incurable. It targets the body's immune system, particularly Cluster of Differentiation 4, a type of white blood cell that helps the immune system fight infections. Pregnant women who are living with HIV/AIDS and have been receiving highly active antiretroviral therapy (HAART), especially the proteaseinhibitor regimen, are at risk of developing gestational diabetes mellitus (GDM). This regimen was deemed sufficient for controlling HIV levels and lowering the chances of passing it from mother to child. However, it hasmany undesirable effects, such astissue insulin resistance. Pregnant women affected by both HIV and GDM often face increased emotional distress and fear that they might pass the conditions to their unborn babies. There is a notable absence of studies on the lived experiences of HIV-positive pregnant women after being diagnosed with GDM in the UGu District of KwaZulu-Natal to support the study. Understanding these lived experiences is important for informing patient-centered care and improving maternal and child health outcomes. Methods: A total of fifteen (n=15) pregnant women with both HIV and GDM were purposively selected to participate in the study. Semi structured face‒to-face individual interviews were used to collect data from the participants. Thematic data analysis was conducted via the Braun & Clarke method of analysis and ATLAS.ti software. Ethical considerations and trustworthiness were adhered to. Results: Six themes and 11 subthemes arose from the study findings, namely, (1) emotional response – fear and anxiety, acceptance and resilience; (2) support systems – family support, healthcare provider support in health; (3) management strategies – dietary changes and exercise, medication adherence; (4) education and awareness – older-person conditions, need for increased awareness, peer support and group education; (5) coping mechanisms – information-seeking behavior; and (6) healthcare recommendations – nurses as healthcare providers. Conclusion: The findings highlight that pregnant women with GDM and HIV/AIDS experience a stressful pregnancy journey, as they must deal with the fear and anxiety associated with the possible complications of comorbid conditions. Experience Gestational diabetes mellitus highly active antiretroviral therapy HIV/AIDS Pregnant women. BACKGROUND Gestational diabetes mellitus is a type of hyperglycemia that starts when a woman is pregnant, making it difficult for her body to control blood glucose levels [ 1 ]. GDM is associated with several health problems for both the baby and the mother. It results in gestational hypertension (GHPT), preeclampsia and an increased risk of developing type 2 diabetes later in the future for the mother, whereas for the baby, GDM can result in the baby growing larger than normal, which is known as macrosomia [ 2 ]. The baby might have breathing problems at birth and an increased likelihood of developing type 2 diabetes in the future [ 2 ]. GDM is a global health concern affecting millions of women, with an estimated prevalence of 16% [ 3 ]. In Southeast Asia, Africa is the second highest contributor to GDM cases among pregnant women worldwide [ 4 ]. South Africa (SA) is reported to have the highest prevalence of diabetes cases in Africa [ 5 ]. The GDM rates in South Africa are between 1.6% and 25.8%, depending on the diagnostic strategies used, but few data exist [ 5 ]. Approximately 3% of SA women of mixed backgrounds were reported to have GDM in the Western Cape; in rural Limpopo, 8.8% of black women had GDM according to the WHO 1999 guidelines, while a prevalence of GDM of 25.8% was observed among black women residing in Gauteng Province [ 6 ]. In KwaZulu-Natal (KZN), where this study took place, there is a 1.6% prevalence of Indian women and 20% prevalence of women of mixed ethnicity with a background of GDM, according to the 1999 WHO guidelines [ 7 ]. Most studies have shown that more HIV-infected mothers develop GDM, but the reasons for this are still unknown [ 8 ]. GDM and HIV/AIDS are two significant health concerns that disproportionately affect pregnant women [ 9 ]. In SA, many people are affected by both HIV and diabetes, especially in KZN [ 5 ]. It is not well understood how common diabetes is among people living with HIV in KZN or what causes it [ 5 ]. The FDA has informed doctors that PI can increase blood glucose levels and lead to diabetes in patients with HIV [ 10 ]. The FDA stated that the advantages of these drugs are greater than any possible problems, and four approved PIs, saquinavir, indinavir, ritonavir, and nelfinavir, carry the same potential side effects of insulin resistance [ 10 ]. The coexistence of GDM and HIV/AIDS in pregnant women poses an increased risk of adverse maternal and fetal outcomes, which include preterm labor, stillborn, neonatal hypoglycemia, delivery via cesarean section, and obesity. According to a scoping review conducted in sub-Saharan Africa, after HIV-positive pregnant women were informed that they had hyperglycemia, they were shocked, upset, and occasionally refused to believe it [ 11 ]. Moreover, they experienced feelings of fear, remorse, and a loss of control over their everyday lives [ 11 ]. According to Arias-Colmenero and colleagues [ 12 ], 33.33% of Spanish articles about pregnant women's experiences and attitudes following an HIV/AIDS diagnosis mentioned feelings of sadness, disappointment, and loneliness because of ignorance of the virus, which led to social isolation and depression. Similarly, Ogueji and colleagues [ 13 ] reported that pregnant women experienced anxious concerns about infecting their unborn babies, whereas others worried more about their future life and not so much about their pregnancy. Research has revealed that GDM can make pregnancy more stressful. The psychological and emotional burden of managing GDM, coupled with concerns about babies’ health, can exacerbate feelings of stress and anxiety in pregnant women [ 14 ]. Another research study conducted in Australia by Devsam et al. [ 15 ] revealed that women not only had negative feelings and thoughts but also faced challenges in managing GDM. They felt that their identity changed from healthy to having GDM. They had to adapt to these changes while worrying about the health of their babies and themselves, and they feared the seriousness of GDM and developing type 2 diabetes [ 14 ]. Furthermore, research indicates that women with GDM often face stigma and discrimination, which may negatively impact their physical and mental well-being [ 16 ]. Despite the increasing prevalence of GDM and HIV/AIDS among women with these conditions in resource-constrained settings such as the UGu District, there is a lack of comprehensive understanding of their experiences in the literature [ 14 ]. The researcher in the present study argues that exploring the lived experiences of pregnant women with GDM and HIV is as important as studying the pathophysiology of these conditions, as exploring the experiences of these women can help healthcare providers adopt a more holistic and empathetic approach to care. Understanding their experiences and challenges enables healthcare providers to deliver more empathetic and patient-centered care. METHODS RESEARCH AIM This study aimed to explore and describe the experiences of pregnant women diagnosed with GDM and HIV/AIDS in the UGu District, with the goal of identifying new challenges and recommendations for improving the outcomes of GDM during pregnancy and beyond. STUDY DESIGN A qualitative exploratory-descriptive and contextual research design was employed in this study via semi structured face-to-face individual interviews. An exploratory-descriptive design was chosen to explore and provide an in-depth explanation of the phenomenon, detect recurring patterns and gain meaningful insight. The researcher adopted a contextual research design to provide an in-depth understanding of the experiences of women with GDM after their diagnosis and how these experiences are shaped by their social, cultural, and environmental context. This study was informed by a constructivist approach, which recognizes that individuals construct their knowledge on the basis of personal experiences and that reality may be experienced differently by different people. To analyze the data, according to Braun & Clarke [ 17 ], thematic analysis was used alongside ATLAS.ti software. STUDY SETTING This research study was conducted in KZN, one of nine provinces in SA, with an estimated population of 12.4 million. It was conducted in a district known as the uGu District, which is made up of four local towns: Umdoni, Umzumbe, Ray Nkonyeni, and Umuziwabantu [ 18 ]. The area has one regional hospital, three district hospitals, two community health centers and one specialized hospital. This study was specifically conducted in Umdoni Local Municipality in a district hospital that has the greatest number of pregnant women with the phenomena under study compared with the other two district hospitals in the UGu District, making it a relevant and data-rich setting for examining the experiences of pregnant women with dual conditions. Second, the selected district hospital is characterized by limited access to specialized maternal healthcare services, which underscores the need to explore the research topic. The study was conducted in both the ANC clinic and postnatal ward in a healthcare facility. RECRUITMENT AND SAMPLING Recruitment of participants started only after ethical approval was received from the North‒West University Health Research Ethics Committee (NWU-HREC), the KZN Department of Health, and goodwill permission from the health facility where the study was conducted. Participants were recruited from the Hospital Antenatal Clinic (ANC), where they attend their routine visits and where the diagnosis of GDM usually occurs, and from the postnatal ward. This hospital facility is reported to have the highest burden of pregnant women receiving HAART and who are diagnosed with GDM [ 19 ]. The mediator (an individual who facilitates communication and coordination between the researcher and potential participants [ 20 ]) used the recruitment flyers provided by the researcher to recruit participants who meet the inclusion criteria and represent the target population. The mediator worked together with an independent person (an individual who does not have a direct role in the research study and can provide an objective perspective [ 20 ]) to identify pregnant women living with both HIV and GDM and invited them to participate in the study. The researcher contacts the independent person to schedule meetings to meet the prospective participants, liaising closely with the mediator, who knows the appointment dates for the prospective participants. The information sessions at the facility comprise the title of the research; the purpose, aim, objective, and significance of the study; and discussions about the consent form and its contents prior to signing the ethical principles and what they entail and how these affect prospective participants. Upon completion of the information session, the researcher and independent person gave the prospective participants at least 48 hours to consider participation. Upon agreeing, they were given an informed consent form to sign in the presence of a witness of their choice. DATA COLLECTION Semi structured individual face‒to-face interviews were used to collect the data for this study [ 21 ]. A flexible interview schedule was designed prior to the interviews and comprised three main questions and probing questions. The advantage of using face-to-face individual interviews enabled the researcher to explore the lived experiences and perceptions of pregnant women after receiving a diagnosis of GDM. They are also helpful in discussing sensitive topics because people usually feel more comfortable sharing in an individual face-to-face conversation than in a group [ 22 ]. Data collection for this study took two weeks. Data were collected during the last week of April 2025 until the end of the first week of May 2025. The participants were aged between 20 and 44 years. The researcher requested a consultation room/space that was private and free from noise, and the “Do not disturb” sign was put on the door once the interviews were ongoing so that no one would disturb the session. To ensure comfort, the researcher ensured that the room had proper lighting, good ventilation, comfortable seating, and available water. Privacy and confidentiality were observed throughout the process. The interviews lasted approximately 15–30 minutes, which was sufficient for exploring the participants’ insights into the topic. As the interviews progressed, no new information was received from the thirteen (n = 13) participants, and data saturation was reached. However, two more participants were interviewed to ensure that data saturation was reached; thus, fifteen (n = 15) participants were interviewed. DATA ANALYSIS An inductive thematic analysis using Braun and Clarke six steps of data analysis was employed to analyze the data in this study [ 17 ]. The ATLAS.ti software was also used for thematic analysis and coding, which were complimentary and thus condensed into the current results. The six phases of thematic analysis include becoming familiar with the data, generating initial codes, generating themes, reviewing potential themes, defining and naming themes, and producing the report. These six phases and software analysis are explained below in terms of how they were followed to analyze the data. Step 1: Familiarize yourself with the data In this phase, the researcher carefully transcribed the data word-for-word by listening to the recorded interviews of the participants and repeatedly captured the participants exact responses. Following transcription, the data were read carefully and repeatedly while the audio recordings were crosschecked for consistency and becoming familiar with the content of the data. Additionally, the transcribed data were sorted, and patterns emerged during the transcription process. Step 2: Generate initial codes The researcher coded the data after attending a coding session with a coding expert to promote accuracy and minimize bias. The researcher also had a co-coding and consensus discussion with the two supervisors, who were the co-coders, to increase the credibility of the research study. The first codes were produced from the transcribed data and thereafter worked systematically through the entire dataset, attending to each data item with equal consideration. Interesting aspects of the data items that might be informative in developing themes were identified. Step 3: Generating for themes Through repeated reading and organizing of the data obtained, the researcher grouped related information into clusters to identify emerging themes and subthemes. Step 4: Reviewing potential themes This step is essentially about quality checking; the researcher checked if the generated themes or subthemes from the participants’ data were functional and if they provided information that addressed the research question. Themes were cross-checked against the transcript to ensure consensus and accuracy of the dataset. Step 5: Defining and naming themes Researcher have examined the data that have been grouped into themes and subthemes and then assigned each group a name that reflects their meaning. A consensus discussion was held with the supervisors to confirm the themes that emerged. Step 6: Producing the report In this step, the researcher outlined the results of different themes and subthemes in a final report. The report was compiled in the form of tables and figures to illustrate the themes and findings while ensuring that the report was aligned with the study methodology and research question. The report was reviewed by the two supervisors, who were the co-coders, to confirm that the results were presented truthfully without bias and in a manner that enhanced the confirmability of the study. ATLAS.ti ATLAS.ti software was used after the researcher analyzed the data manually, using six phases of thematic analysis. The researcher uploaded the transcribed data document to the ATLAS.ti system. She then read through the transcribed data and made initial memos or comments and began to develop a feeling of patterns in the data. Codes were created from the patterns noted in the data and were applied to text segments across all the documents. The researcher created codes inductively. Related codes were grouped into code families or categories that presented themes, and related subthemes were grouped under their main themes. The researcher then combined all the findings into a written report, as shown in Table 1 below. The results generated via ATLAS.ti software were similar to the results obtained when the data were analyzed manually. RESULTS A total of fifteen (n = 15) participants were interviewed using semi structured individual face‒to‒face interviews over a period of two weeks. The participants’ ages ranged from 20–44 years. The interviews covered several aspects of GDM and HIV/AIDS; to facilitate comprehension of GDM, the terminology had to be changed to “sugar in blood” (as it was the term known to most of the participants), which was used while interviewing them. Several themes emerged from the data and are reported below, with participants’ quotes presented to support the themes. THEMES Seven major themes emerged from the analysis, notably emotional response, support systems, management strategies, education and awareness, coping mechanisms and healthcare recommendations, followed by several subthemes, as outlined in Table 1 below. These themes and subthemes are discussed below, together with supporting data. Table 1 Summary of themes and subthemes Themes Subthemes 1. Emotional response 1.1 Fear and anxiety 1.2 Acceptance and resilience 2. Support systems 2.1 Family support 2.2 Healthcare provider support in health facility 3. Management strategies 3.1 Dietary changes and exercise 3.2 Medication adherence 4. Education and awareness 4.1 Older-person condition 4.2 Need for increased awareness 4.3 Peer support and group education 5. Coping mechanisms 5.1 Information-seeking behavior 6. Healthcare recommendations 6.1 Nurses as healthcare providers Theme 1: Emotional response The participants described a range of emotional reactions following their initial diagnosis with GDM. Two subthemes emerged, namely, fear and anxiety and acceptance and resilience. Fear and anxiety The initial reaction to the diagnosis of GDM for many participants was marked by fear, sadness, and uncertainty about the potential consequences of GDM for both themselves and their unborn child. This was particularly evident among those who had limited prior knowledge of the condition. For example, one participant stated, “I was scared because at that time, I didn’t know more about what GDM was and if me and my unborn baby are going to be fine” (P12, 38 years old). Similarly, another expressed deep concern: “I was very sad after finding out about my diagnosis because at first the concept GDM was new to me, so I didn’t know if me and my unborn baby were going to die” (P6, 33 years old). Acceptance and resilience Over time, many participants demonstrated a shift from distress to acceptance, often facilitated by counseling and support from healthcare professionals. For example, one participant explained, “I was scared when I was informed that I had GDM, but I ended up accepting after receiving counseling, the nurse explained the condition very well, and she allayed my anxiety.” (P15, 27 years old). Others reframed their diagnosis as a manageable challenge, as in one participant’s account: “After being diagnosed, I had no choice but to accept it because I believe that the first thing to do is acceptance before even taking the medication.” (P4, 34 years old). Overall, the trajectory from fear and anxiety to acceptance and resilience suggests that while an initial GDM diagnosis can trigger emotional distress, targeted health education and psychosocial support can facilitate positive adjustment. Theme 2: Support system The participants reported that they received strong emotional and practical support from family members and healthcare providers, which enabled them to cope better with GDM. The support included dietary adjustments made by family members and ongoing counseling from healthcare professionals. Two subthemes emerged: family support and healthcare provider support in health facilities. Family support A recurring theme was the contribution of family to offering emotional and practical support. The participants noted that their families often adjusted their diets and routines to accommodate their needs. For example, one participant stated, “ My support structure is very good because the food I need to avoid eating during these nine months is not present in my home. Everyone is involved in healthy eating; I am not doing it by myself” (P1, 34 years old). Another participant echoed: “ My family support me emotionally mostly, and they are considerate when I visit them; they change their diet to accommodate me; we all eat healthy together” (P2, 35 years old) Similarly, another participant stated the following: “ My family supports me financially, and they are considerate. They can change the way they eat in order to accommodate me” (P14, 41 years old). Healthcare provider support in health facilities The participants highlighted the importance of supportive healthcare providers at healthcare facilities who offered counseling and health education about managing GDM. Many patients were reassured by the information and guidance provided by these healthcare providers. The support that was received from the healthcare providers was expressed by the participants as follows: “ The support I receive from healthcare providers is counseling. They make sure that they gave me counseling after being diagnosed, and they explained in-depth about the disease” (P10, 30 years old). Another participant reflected: “ The support I receive from the health providers is mostly information about the condition and advice on how to ensure that I manage the condition, so it doesn’t affect my health” (P8, 36 years old). A strong support system comprising both family and healthcare providers plays a significant role in enhancing the physical and emotional health of pregnant women with HIV and GDM. This integrated support system not only improves maternal and fetal health outcomes but also mitigates the psychosocial burden associated with managing dual health conditions during pregnancy. Theme 3: Management strategies The participants noted the importance of incorporating a healthy lifestyle in managing their condition to prevent complications. Responses to this theme revealed the effective management of GDM, focusing on dietary changes, regular exercise, and adherence to medication, which are the subthemes that emerged from this theme and are discussed below with participant codes. Dietary changes and exercise A common pattern was the emphasis on dietary management and exercise as a primary strategy for controlling GDM. The participants discussed the importance of eating balanced meals, avoiding high-sugar foods, and maintaining regular mealtimes. For example, one participant stated, “ Diet is my number one other than medication. If I can control my blood glucose well now using diet, eating well-balanced meals, and exercising, I don’t have to put my body and the baby in all the stress of taking medication” (P1, 34 years old). Several participants shared the following: “There is nothing more to do than eating a healthy and well-balanced diet, exercising more often and drinking lots of water at least eight glasses a day” (P2, 35 years old; P14, 41 years old; P15, 27 years old). Medication adherence The participants also recognized the necessity of adhering to prescribed medications when dietary changes alone were insufficient. They expressed concerns about becoming dependent on medication but acknowledged its importance in managing their condition. Participant 1 mentioned the following: “ If I can control my blood glucose well now using diet, eating a well-balanced meal I don’t have to put my body and the baby in all the stress of taking medication because should I start taking medication now my body will become dependable and it’s going to be a problem” (P1, 34 years old). The same participant further explained: “Additionally, they must find other ways of managing the condition before rushing into medication because there are side effects of medication, and one can be dependent on them so they must come up with better solutions such as herbal solutions or dietary solutions and exercises and not just jump into medication” (P1, 34 years old). Another participant added: “ Taking medication on time and as instructed by the nurses is important to manage the condition and eliminate the health risk that might come with not taking treatment as prescribed” (P3, 34 years old). Effectively managing both HIV and GDM during pregnancy necessitates a comprehensive strategy focused on lifestyle modification and medication adherence. Implementing tailored dietary plans, encouraging regular exercise, and ensuring consistent treatment adherence are critical components that contribute to maternal metabolic control and viral suppression. Theme 4: Education and awareness Most participants understood the concept of GDM as “sugar in blood” and had little knowledge of it. Although they were somewhat familiar with diabetes to some extent, they lacked an in-depth understanding of it, as they thought that the condition only affects older people. Three subthemes emerged from this theme: older person condition, need for increased awareness, and peer support and group education. Older-person condition Some participants did not know that diabetes can occur during pregnancy, as they associated it with an older person’s condition, as reflected in the following quotes: “ What I know about GDM is that it is dangerous and affects older people. A person with GDM must eat every hour because if not the person gets weak.” (P12, 38 years old). An additional participant openly expressed the following: “ I don’t know what GDM is, but I always hear about it; they say it is a deadly condition that usually occurs in older people most of the time” (P5, 27 years old). Need for increased awareness Many participants called for more awareness campaigns about GDM, particularly in ANC settings, as they are well informed about HIV/AIDS during pregnancy. They felt that better education could alleviate fears and misconceptions surrounding GDM during pregnancy. One participant stated: “What I know is that when someone has GDM, he or she will develop a wound that will not heal, and the wound will ooze pus then lead to amputation, I do not truly know what GDM does during pregnancy beside amputation” (P3, 34 years old). Another participant noted what she knew about GDM: “ What I know is that GDM is deadly, it can kill, it can happen that when time goes by you get amputation, it can be in your leg or in your hand” (P4, 34 years old). While for HIV/AIDS in pregnancy, the participants reflected that they were aware of the condition, for example, participant 1, a 34-year-old, stated: HIV/AIDS is a condition that can spread from person to person through unprotected sex, having a needle prick of an infected person, if you are pregnant and you take your medication well and never skip a day you will not infect your unborn child, so it is important to adhere to HIV treatment when you are pregnant. Another participant further explained that: “HIV/AIDS is like GDM. It is also found in the blood, but it can be spread from mom to baby if the mom is not taking medication well” (P2, 35 years old). Similarly, other participants explained the following: “HIV/AIDS is a disease that affects the body’s immune system, and it can be spread from person to person in various ways, such as unprotected sex. During pregnancy, the mother must take her medication every day on time to lower the chances of passing the virus to the unborn child” (P3, 34 years old; P4, 34 years old; P5, 27 years old; and P6, 33 years old). Peer support and group education Some participants suggested the creation of support groups for women with GDM, emphasizing the benefits of sharing experiences and coping strategies. For example, one participant stated: “ They should do more awareness campaigns on what gestational diabetes is because we have more awareness on what diabetes is but in regard to GDM it’s just general; there is no emphasis on it” (P1, 34 years old). Another participant stated: “ have/create support groups for women with these conditions, so they can encourage each other and remind each other of the time to medication, ensuring that everyone is okay”. “ Nurses must teach us more about conditions that can occur or happen to us during pregnancy, how to prevent them or how to manage the condition we already have them. Give more health education about these conditions” (P7, 20 years old). Furthermore, another participant reiterated: “ They must give us more health education about these types of conditions and let it be an ongoing thing and not only educate us after diagnosis they must also offer counseling more often not after being diagnosed only so that we can be more informed and confident about the disease” (P12, 38 years old). Increasing education and awareness is essential for supporting pregnant women living with both HIV and GDM. Increased awareness, peer support and group education not only enhance understanding and adherence to care but also help reduce stigma and isolation, empowering these women through targeted educational initiatives designed to promote better health outcomes for both mothers and their babies. Theme 5: Coping mechanisms The participants in this theme revealed what they did initially after being diagnosed with GDM, which led them to be able to cope, live with and manage the condition. One subtheme emerged from this theme, namely, information-seeking behavior. Information-seeking behavior The participants often sought additional information about GDM through research and consultations with healthcare providers. This proactive approach helped them feel more in control of their health. Participant 2, 35 years old, mentioned the following: I attended counseling, which helped me a lot and gave me more information about the condition. Similarly, another participant remarked: “ I went on and sought more information by asking the nurse what the condition is and how can I manage and protect myself and my unborn child” (P5, 27 years old). Another participant mentioned: “ I went on and sought more information about GDM just to gain more insight into the condition; then, it was easy for me to accept and start doing the exact things the nurses said I must do” (P4, 34 years old). A final perspective came from the participant, who stated the following: “I went on and sought more information about the condition of what it is and how I can protect or prevent it from becoming complicated and affecting my health” (P9, 26 years old). Seeking information emerged as a critical coping mechanism for pregnant women diagnosed with both HIV and GDM. By proactively acquiring knowledge, these women were able to gain a clearer understanding of their situation, follow treatment plans more effectively, interact more confidently with healthcare providers and be able to make informed decisions throughout pregnancy. Theme 6: Healthcare recommendations The participants emphasized the need for healthcare workers to be approachable, maintain patient confidentiality, and be open and understanding. One subtheme emerged from the main theme, namely, “Nurses as healthcare providers,” and is discussed below. Nurses as healthcare providers To support this theme, one participant stated: “ Nurses must be professional; they must not disclose one patient’s information to another patient. Like other nurses after you leave the consultation, he/she will talk about you to the next patient” (P5, 27 years old). Another participant further explained: “Nurses must not be rude, they must speak well with patients and not always threaten them by telling them that if they don’t do what they tell them they will die, they must not make patients scared but speak to them in a manner that they will understand and not be scared to ask or answer questions asked” (P8, 36 years old). Another participant reflected that: “Nurses must treat us exactly like everyone else don’t have discrimination because separating us will be the most hurtful thing because the only difference is that we have these diseases” (P9, 26 years old; P11, 25 years old). Nurses play an important role in the delivery of comprehensive care and education to pregnant women who have both HIV and GDM. Strengthening their involvement through targeted training and supportive policies enhances patient outcomes, improves care continuity and fosters trust in pregnant women. They serve as frontline healthcare providers and are instrumental in delivering holistic, patient-centered care to pregnant women. Their role extends beyond clinical management to include education, emotional support, and advocacy. DISCUSSION This exploratory-descriptive and contextual study provides a better understanding of the lived experiences of pregnant women diagnosed with GDM and HIV/AIDS. Like the other qualitative findings discussed below, this study produced valuable data on pregnant women’s experiences living with both GDM and HIV/AIDS. To the best of our knowledge, this study is the first in the uGu District of KZN to reveal the lived experiences, thoughts and feelings of pregnant women with these comorbid conditions. Six main themes and 11 subthemes were obtained from coding this study and are discussed below. The diagnosis of GDM represented a traumatic turning point for the participants in this study, triggering strong emotions that align with prior studies [ 11 , 23 ]. The results of this study revealed that when HIV/AIDS pregnant women were first diagnosed with GDM, they experienced many negative thoughts, stress, anxiety and fear concerning the health and safety of their unborn baby. Similar findings were noted in a review examining women’s experiences with a GDM diagnosis, highlighting that being diagnosed with a health condition such as GDM can adversely influence a pregnant woman’s quality of life due to fears regarding the possibility of the illness affecting her and/or her baby [ 14 ]. A concurrent outcome was found in a qualitative study performed in western Turkey, which revealed that pregnant women who were diagnosed with GDM and HIV were concerned about the potential effect on their unborn children. They fear that their babies will be born with the conditions [ 23 ]. Other researchers have noted that although the initial diagnosis of GDM can cause significant anxiety in pregnant women, this anxiety may not last long [ 24 , 25 ]. In this research study, this appeared to be the case for some pregnant women, as they mentioned that they were scared and anxious at first, but they later accepted the diagnosis. This study revealed that recognizing how pregnant women with HIV feel about GDM diagnosis is important for developing suitable interventions and enhancing their care throughout their pregnancy journey. Another key finding of this study is that the family plays a significant role in providing emotional and practical support. The participants in this study reported that their families often adjusted their diets and routines to accommodate their needs. A contemporaneous qualitative study on perceived needs in women with GDM indicated that support from family members and friends effectively affected the participants’ decision to choose healthier lifestyles. Support encourages pregnant women to believe that they are well cared for, whereas a lack of support makes pregnant women feel more vulnerable and that their friends and family members have abandoned them [ 15 , 26 ]. Furthermore, the results of this study highlight the importance of supportive healthcare providers at healthcare facilities who offer counseling and education about managing GDM. Many participants were reassured by the information and guidance provided by nurses. These findings are in line with those of prior studies, highlighting that customized education and compassionate communication from healthcare providers greatly enhance self-care practices and glycemic management in pregnant women living with GDM [ 27 , 28 ]. A narrative review study also revealed that interventions conducted by healthcare professionals, particularly nurses offering informational, motivational, and emotional assistance, resulted in improved self-care practices, better glycemic regulation, and increased self-efficacy in women with GDM [ 29 ]. The findings from a case‒control study conducted in Ankara, Turkiye emphasized that organized diabetes education programs provided by nurses and multidisciplinary teams were associated with improved glycemic control, reduced weight gain during pregnancy, and lower insulin requirements among women diagnosed with GDM [ 30 ]. Our results align with a robust body of literature showing that healthcare providers who are supportive and focused on patients’ needs by offering personalized counseling, organized education, and continual emotional assistance significantly enhance self-management and good pregnancy outcomes in HIV-positive pregnant women with GDM. The results of this study also revealed the effective management of GDM, with a focus on dietary changes, regular exercise and adherence to medication. The participants noted the importance of a healthy lifestyle in managing their condition and preventing complications. A common pattern was the emphasis on dietary management and exercise as a primary strategy for controlling GDM. The participants discussed the importance of eating well-balanced meals and exercising frequently to manage their condition. Unsurprisingly, pregnant women valued managing their diabetes and understood its significance for both their well-being and that of their babies. Smyth and colleagues [ 31 ] reported similar results, emphasizing that diet and exercise are the cornerstones of GDM management. Another comparable phenomenological study on insulin use in GDM highlighted that pregnant women affected by GDM may first follow a healthy diet and exercise plan on the basis of their body weights [ 32 ]. Similarly, the ADA recommends that nutrition therapy and physical activity interventions be used as first-line treatments for the management of GDM [ 33 ]. However, women reported that the diagnosis increased their responsibility because they now had to take extra precautions concerning their dietary regimens [ 34 ]. The participants in this study also recognized the need to adhere to prescribed medications when dietary changes alone were insufficient. They expressed concerns about becoming dependent on medication but acknowledged its importance in managing their condition. A recent literature review on GDM conducted in Poland by Modzelewski et al. [ 35 ] further explained that when the basic method of managing GDM is inadequate, pharmacotherapy can be used to intensify treatment, such as insulin, glibenclimide and metformin, but insulin therapy is usually used [ 35 ]. This finding aligns with the results of a comprehensive review by Nakshine and Jogdand [ 36 ], which highlighted that pharmacotherapy can be an option in patients whose blood glucose level cannot be managed with a well-balanced diet and lifestyle modification. The results of this study demonstrated that knowledge about GDM is insufficient. Out of the 15 participants in this study, ten (n = 10) participants, accounting for 66.67% of all participants, lacked awareness of GDM. Furthermore, other participants possessed some knowledge of what “sugars in blood” meant, but they could not relate this condition to GDM. Surprisingly, other participants demonstrated an understanding of what diabetes is, but they were not aware that it could happen during pregnancy, as they mistakenly believed that the condition affected only older persons. These findings are similar to the findings observed in a cross-sectional survey performed in Nigeria by Ogu et al. [ 37 ], which revealed that only a limited number of participants possessed excellent knowledge of GDM [ 37 ]. Many participants called for more awareness campaigns about GDM, particularly in ANC settings. They felt that better education could alleviate fears and misconceptions surrounding the condition. One participant emphasized that healthcare workers should conduct more awareness campaigns on what GDM is because they are more aware of diabetes and HIV/AIDS, but in regard to GDM, there is little knowledge sharing. These findings align with the findings from a qualitative systemic review study highlighting that, during the interviews, participants frequently talked about needing more education. Women expressed a need for increased awareness and additional support [ 38 ]. A lack of adequate information has also been highlighted in other studies [ 25 ] as an important factor leading to confusion, frustration and helplessness among pregnant women with GDM. Some participants suggested the creation of support groups for women with GDM, emphasizing the benefits of sharing experiences and coping strategies. Two of the participants mentioned that it would be beneficial for them if they could have support groups for all pregnant women with these conditions so that they could encourage each other and remind each other of the time to take medication and ensure that everyone is coping. Rice et al. [ 39 ] reported that peer support appears to be incredibly important to pregnant women. It improves their overall experience, reduces feelings of isolation, and could be an underutilized resource by healthcare providers. In this study, diabetes during pregnancy was not given much attention because it was seen as a less serious and temporary condition; therefore, more emphasis on GDM is needed in health facilities to increase awareness. The participants in this study revealed what they did initially after being diagnosed with GDM, which led them to be able to cope with and live with the condition. They further disclosed what helped them to be able to accept and learn to live and manage their condition, including seeking additional information about GDM through research and consultations with healthcare providers. This proactive behavior helped them feel more in control of their health. Several participants highlighted that they went on and sought more information about GDM to gain more insight into the condition and be well informed about it. Notably, most women in the current study were able to overcome the initial shock and anxiety following GDM diagnosis and gradually made the necessary adjustments to living with GDM. Their perceived anxiety did not increase as the pregnancy progressed, suggesting that it could be reactive anxiety triggered by the unexpected diagnosis of GDM as opposed to intrinsic anxiety. A concurrent qualitative study on the experiences of women with GDM in Singapore highlighted that, at first, many women experienced a sense of “shock” regarding the diagnosis of GDM and believed that they did not receive enough information from their healthcare providers. After the diagnosis, they then went ahead and sought additional guidance on their own on the internet and became more knowledgeable about the condition [ 40 ]. A similar finding in another qualitative research study further suggested that pregnant women reported actively seeking information and guidance to better understand GDM and care [ 41 ]. These findings demonstrated the importance of prompt and transparent counseling led by healthcare providers during diagnosis to assist pregnant women, especially those dealing with HIV and GDM, in becoming knowledgeable, self-assured, and empowered in taking charge of their health. The findings of this study also emphasized the need for healthcare workers to be approachable, open, and friendly and to maintain patient confidentiality. Several participants highlighted that healthcare providers had to maintain confidentiality at all times during the interviews. They had to communicate well with them and not speak to them in a manner that would prevent the patient from sharing when they are not feeling well or having any problems. Some participants also reported that nurses had to treat them exactly like everyone else and not discriminate against them. Healthcare providers must provide accurate information and maintain women’s willingness to attend subsequent ANC visits [ 38 ]. The perceived importance of health professionals in providing information, awareness and support for women with GDM was evident in this study. The impact of healthcare provider‒patient relationships resonated throughout the narrative and is supported by qualitative research describing the importance of health professional support and patient‒provider interactions. Professional health support may also be an important determinant of longer-term health status [ 24 ]. In light of increasing rates of GDM, this will pose a challenge for healthcare providers to adequately support all women diagnosed with GDM both now and in the future [ 24 ]. STUDY STRENGHTS AND LIMITATIONS To the best of our knowledge, this study is the first to explore and document the lived pregnancy experiences of women concurrently living with HIV and GDM in the UGu District of KwaZulu-Natal. This contributes valuable insight into the limited scholarly discourse on maternal health within resource-constrained settings characterized by a high burden of disease and provides a foundation for subsequent investigations. A further strength lies in the diversity of participant responses, which enhances the credibility of the findings and indicates a reduced likelihood of response bias. Consistency during data collection was promoted by having all interviews conducted by a single researcher, thereby ensuring uniformity in interviewing style and approach. Despite these strengths, several limitations should be acknowledged. The study utilized a relatively small and geographically limited sample, which may affect the transferability of the findings to other settings. Furthermore, as the interviews were conducted by a single researcher, the potential for interviewer bias cannot be entirely excluded, despite efforts to maintain neutrality. The self-reported nature of the data may also be subject to recall or social desirability bias. Finally, the cross-sectional design limits the ability to capture changes in experiences over time. Nevertheless, many of the predefined themes were brought up by the women themselves to achieve the research objectives, and follow-up questions were often used to confirm or refute the relevance of those themes in the overall project. IMPLICATION FOR PRACTICE The results of this study have implications for both future research and nursing practice. They revealed a significant gap in the nursing research literature regarding the lived experiences of pregnant women diagnosed with both HIV and GDM. While research on each condition individually is extensive, there is limited empirical evidence exploring the intersection of these two diagnoses, particularly from a patient-centered perspective. To fill this gap and inform future interventions, more qualitative studies such as this one are needed. The results of this research study also highlight significant considerations for nursing practice, specifically in improving the management and treatment of pregnant women living with GDM and HIV. The research findings emphasize key aspects where nursing care can be enhanced to foster better health outcomes for pregnant women and their babies. These include health education, patient communication, emotional support, confidentiality and equitable treatment. One significant finding reveals that there is a deficiency in awareness and health education regarding GDM, both in the general public and within standard ANC services. It is suggested that nurses take an active role in creating and implementing focused health education programs centered around GDM. These programs should be incorporated into ANC to improve awareness of the condition, its associated risk factors and how to manage it effectively. Regular educational sessions can equip women with knowledge, alleviate their anxiety related to the diagnosis and promote compliance. CONCLUSION The findings of this study emphasize that pregnant women with GDM and HIV/AIDS experience a stressful pregnancy journey, as they must deal with the fear and anxiety associated with the possible complications of these two comorbidities. The findings also revealed that these women are very concerned that they may pass the conditions to their unborn child. Although GDM typically resolves after birth, it has long-lasting impacts on pregnant women. Given the increasing frequency of GDM in HIV-infected pregnant women and its various psychosocial effects, the results of this study emphasize the importance for healthcare professionals to recognize not only the consequences of a GDM diagnosis for pregnant women but also their experiences of living with this condition. This study also revealed that it is crucial that pregnant women diagnosed with GDM obtain regular, personalized, evidence-based information along with continuous psychological and social assistance. This qualitative study provides evidence that the clinical care that pregnant women receive can negatively affect their pregnancy experience. Declarations ETHICS APPROVAL AND CONSENT TO PARTICIPATE Ethical approval was received from the university, Ethics Number: XXX-00090-24-A1-01, KZN Department of Health, and the goodwill permission from the hospital facility was obtained. Written informed consent was obtained from the participants before the data collection process began. CONSENT FOR PUBLICATION Not applicable COMPETING INTEREST The authors declare that they have no competing interests. AUTHORSHIP CONTRIBUTION STATEMENT All the authors contributed to the conceptualization of the study. ZPN and NEB participated in the study investigation, that is, in enrolling participants and data collection. The analysis was completed by ZPN, who also developed the final coding; NEB and KDS co-coded the data. ZPN wrote the initial manuscript draft, which was critically reviewed and commented on by NEB and KDS. The final version was approved by all the authors. FUNDING INFORMATION The study is funded by the National Research Foundation (NRF) of South Africa, Thuthuka Project (Grant number: TK23042095297). However, all the opinions, findings, and conclusions are solely those of the authors and are not associated with the NRF in any way. Author Contribution All the authors contributed to the conceptualization of the study. ZPN and NEB participated in the study investigation, that is, in enrolling participants and data collection. The analysis was completed by ZPN, who also developed the final coding; NEB and KDS co-coded the data. ZPN wrote the initial manuscript draft, which was critically reviewed and commented on by NEB and KDS. The final version was approved by all the authors. Acknowledgement The authors would like to sincerely thank all the participants who volunteered their time to take part in this research and share their experiences, joy and fears. Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. References World Health Organization. Diabetes.. 2024. https://www.who.int/news-room/fact-sheets/detail/diabetes Date of access: 12 Jan. 2025. Bukasa LL, Cortina-Borja M, Peters H, Taylor GP, Thorne C. Gestational diabetes in women living with HIV in the UK and Ireland: insights from population-based surveillance data. Afr J Reprod Gynecol Endoscopy. 2023;26:e26078. https://doi.org/10.1002/jia2.26078 . Chebrolu, P., Alexander, M., Bhosale, R., Naik, S., Gupte, N., Lee, M.H., … Mathad,J.S. The Association of Gestational Diabetes with HIV infection and tuberculosis in Indian women. The American Journal of Tropical Medicine and Hygiene. 2022; 107:569.https://www.ajtmh.org/abstract/journals/tpmd/107/3/article-p569.xml. Saez-de-Ibarra I, Lopez-Gonzalez D, Diaz-Redondo A. Global prevalence of gestational diabetes mellitus: A systematic review and meta-analysis. Diabetes Res Clin Pract. 2022;187:109849. https://doi.org/10.1016/j.diabres.2022.109849 . Umar DM, Naidoo P. Prevalence and predictors of diabetes mellitus among persons living with HIV: a retrospective cohort study conducted in 4 public healthcare facilities in KwaZulu-Natal. BMC Public Health. 2021;21:288. 10.1186/s12889-021-10318-6 . https://bmcpublichealth.biomedcentral.com/articles/ . Dias S, Adam S, Rheeder P, Pheiffer C. Prevalence of and risk factors for gestational diabetes mellitus in South Africa. South Afr Med J. 2019;109:463–7. https://doi.org/10.7196/SAMJ.2019.v109i7.14127 . Huddle KR, MoldMould TA. Gestational diabetes mellitus in a multi-ethnic population in KwaZulu-Natal. South Afr Med J. 2020;110:340–4. Falasca K, Ucciferri C, Mancino P, Di Nicola M, Vecchiet J, Manzoli L. Gestational diabetes mellitus in HIV-infected women: A review. J Med Virol. 2020;92:1725–33. 10.1002/jmv.25844 . https://onlinelibrary.wiley.com/doi/full/10.1002/jmv.25844 . UNAIDS. UNAIDS data. 2022. https://www.unaids.org/sites/default/files/media_asset/data-book-2022_en.pdf Date of access: 28 Jul. 2024. Sarkar S, Brown TT. Diabetes in people living with HIV . 2023. https://www.ncbi.nlm.nih.gov/books/NBK545886/ Date of access: 20 Jul.2025. Akinsolu, F.T., Adewole, I.E., Lawale, A., Olagunju, M.T., Abodunrin, O.R., Ola, O.M.,… Chukwuemeka, A.N. HIV and pregnancy among adolescents in sub-Saharan Africa: A scoping review. medRxiv. 2024;04. https://doi.org/10.1101/2024.04.25.24305581. Arias-Colmenero T, Pérez-Morente MÁ, Ramos-Morcillo AJ, Capilla-Díaz C, Ruzafa-Martínez M, Hueso-Montoro C. Experiences and attitudes of people with HIV/AIDS: A systematic review of qualitative studies. Int J Environ Res Public Health. 2020;17:639. https://doi.org/10.3390/ijerph17020639 . Ogueji IA. Experiences and predictors of psychological distress in pregnant women living with HIV. Br J Health Psychol. 2021;26:882–901. https://doi.org/10.1111/bjhp.12510 . Craig L, Sims R, Glasziou P, Thomas R. Women’s experiences of a diagnosis of gestational diabetes mellitus: a systematic review. BMC Pregnancy Childbirth. 2020;20:76. https://doi.org/10.1186/s12884-020-2745-1 . Devsam BU, Bogossian FE, Peacoc AS. An interpretive review of women’s experiences of gestational diabetes mellitus: Proposing a framework to enhance midwifery assessment. Women Birth. 2013;26:69–76. https://doi.org/10.1016/j.wombi.2012.12.003 . Davidsen E, Maindal HT, Rod MH, Olesen K, Byrine M, Damm P. Nielsen. K.K. The stigma associated with gestational diabetes mellitus: Scoping Review. Lancet. 2022;52:10. https://doi.org/10.1016/j.eclinm.2022.101614 . Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health . 2019. 11(4), 589–97. https://doi.org/10.1080/2159676X.2019.1628806 Department of Health (South Africa). Referral system: levels of healthcare.. 2023. https://www2.kznhealth.gov.za/Referral-system.htm . Date of access: 2 Jun. 2025. Nyasulu, P.S., Ngasama, E, Tamuzi, J.L., Sigwadhi, L.N., Ozougwu, L.U., Nhandara,R.B.C., … Ayele, B.T. Effect of HIV status and antiretroviral treatment on treatment outcomes of tuberculosis patients in a rural primary healthcare clinic in South Africa.PLoS One. 2022; 17:e0274549.https://doi.org/10.1371/journal.pone.0274549. Flick U. An introduction to qualitative research. 6th ed. London: SAGE; 2020. pp. 140–57. Meyer S, Naude M, Shangase NC, Van Niekerk SE. The nursing unit management: A comprehensive guide. 3rd ed. South Africa, SA: Pearson (Pty) Ltd; 2022. pp. 47–56. Upmetrics Staff. 8 essential qualitative data collection methods.. 2022. https://blog.upmetrics.com/essential-qualitative-data-collection-methods Date of access:19 Aug. 2024. Ören EDT, Avdal EÜ, Polat G, Sofulu F, Düzgün G, Pamuk G. Experiences of women with gestational diabetes about fear of having diabetes in their babies: A qualitative study. Medicine. 2024;103:e37755. https://pmc.ncbi.nlm.nih.gov/articles/PMC11018210/ . Morrison MK, Hayes L, Shand AW, Caterson ID. Gestational diabetes mellitus in HIV-positive women: A systematic review and meta-analysis. Diabetes Res Clin Pract. 2020;159:107934. http://doi.org/10.1016/j.diabres.2020.107934 . Muhwava LS, Murphy K, Zarowsky C, Levitt N. Perspectives on the psychological and emotional burden of having Gestational Diabetes amongst low-income women in Cape Town, South Africa. BMC Womens Health. 2020;20:231. https://doi.org/10.1186/s12905-020-01093-4 . Khooshehchin TE, Keshavarz Z, Afrakhteh M, Shakibazadeh E, Faghihzadeh S. Perceived needs in women with gestational diabetes: A qualitative study. Electron Physician. 2016;8:3412. https://www.ephysician.ir/2016/3412.pdf . Haron Z, Sutan R, Zakaria R, Mahdy ZA. Self-care educational guide for mothers with gestational diabetes mellitus: A systematic review on identifying self-care domains, approaches, and their effectiveness. Belitung Nurs J. 2023;9:6. https://www.belitungraya.org/BRP/index.php/bnj/article/view/2396 . Xu N, Han X, Chen S, Zhang J, Gu P. Self-reported barriers in self‐management of women with gestational diabetes: A systematic review of qualitative studies. Nurs Open. 2023;10:7130–43. 10.1002/nop2.1988 . https://onlinelibrary.wiley.com/doi/full/ . Dailah HGJ. The influence of nurse-led interventions on diseases management in patients with Diabetes Mellitus: a narrative review. Healthcare. 2024;12:352. https://doi.org/10.3390/healthcare12030352 . Topkara S, Soysal Ç. The effect of diabetes education on maternal and neonatal outcomes in pregnant women diagnosed with gestational diabetes. BMC Pregnancy Childbirth. 2024;24:747. 10.1186/s12884-024-06971-5 . https://bmcpregnancychildbirth.biomedcentral.com/articles/ . Smyth S, Mulligan K, Rutter E, Harrington L, Hatunic M, Higgins MF. Attitudes of women with gestational diabetes toward diet and exercise: a qualitative study. J Maternal-Fetal Neonatal Med. 2023;36:2155045. https://doi.org/10.1080/14767058.2022.2155045 . Düzgün G, Polat G, Avdal EÜ. Perspective on insulin use in gestational diabetes: A phenomenological study. Medicine. 2023;102:e35831. https://journals.lww.com/md-journal/fulltext/2023/12080/perspective_on_insulin_use_in_gestational.74.aspx . Dunne P, O'Mahony L, Culliney L, Byrne M, Murphy AW. O'Reilly, SExploring the lived experience of women with gestational diabetes: A cross-sectional Irish national survey. Diabet Med. 2025;42:e15489. https://doi.org/10.1111/dme.15489 . Karavasileiadou S, Almegewly W, Alanazi A, Alyami H, Chatzimichailidou S. Self-management and self-efficacy of women with gestational diabetes mellitus: a systematic review. Global Health Action. 2022;15:2087298. 10.1080/16549716.2022.2087298 . https://www.tandfonline.com/doi/full/ . Modzelewski R, Stefanowicz-Rutkowska MM, Matuszewski W, Bandurska-Stankiewicz EM. Gestational diabetes mellitus – recent literature review. Journal of Clinical Medicine . 2022; 11:5736. https://www.mdpi.com/2077-0383/11/19/5736 Nakshine VS, Jogdand SD. A comprehensive review of Gestational diabetes mellitus: impacts on maternal health, fetal development, childhood outcomes, and long-term treatment strategies. Cureus. 2023;15. https://doi.org/10.7759/cureus.47500 . Ogu RN, Maduka O, Agala V, Alamina F, Adebiyi O, Edewor U, Porbeni I, Abam C. Gestational diabetes mellitus knowledge among women of reproductive age in southern Nigeria: Implications for diabetes education. Int Q Community Health Educucation. 2019;40:177–83. https://www.ncbi.nlm.nih.gov/pubmed/31554478 . Al-Mutawtah M, Campbell E, Kubis HP, Erjavec M. Women’s experiences of social support during pregnancy: a qualitative systematic review. BMC Pregnancy Childbirth. 2023;23:782. https://doi.org/10.1186/s12884-023-06089-0 . Rice C, Ingram E, O’Mahen H. A qualitative study of the impact of peer support on women’s mental health treatment experiences during the perinatal period. BMC Pregnancy Childbirth. 2022;22:689. 10.1186/s12884-022-04959-7?utm . https://bmcpregnancychildbirth.biomedcentral.com/articles/ . Lazarus MA, Lee VV, Ong DLS, Yew TW, Shorey S, Young D, Eriksson JG. Understanding the experiences of women with gestational diabetes in Singapore: A qualitative study. Int J Women's Health. 2025; 1711–24. https://www.dovepress.com/understanding-the-experiences-of-women-with-gestational-diabetes-in-si-peer-reviewed-fulltext-article-IJWH Sahu, B., Babu, G.R., Gurav, K.S., Karthik, M., Ravi, D., Lobo, E. … Kinra, S. Healthcare professionals’ perspectives on screening and management of gestational diabetes mellitus in public hospitals of South India–a qualitative study. BMC Health Services Research. 2021; 21:133. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06077-0?utm. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 31 Dec, 2025 Reviews received at journal 27 Dec, 2025 Reviewers agreed at journal 21 Dec, 2025 Reviewers agreed at journal 21 Dec, 2025 Reviews received at journal 19 Dec, 2025 Reviewers agreed at journal 19 Dec, 2025 Reviews received at journal 19 Dec, 2025 Reviewers agreed at journal 18 Dec, 2025 Reviewers agreed at journal 14 Dec, 2025 Reviewers invited by journal 12 Dec, 2025 Editor invited by journal 20 Nov, 2025 Editor assigned by journal 20 Nov, 2025 Submission checks completed at journal 20 Nov, 2025 First submitted to journal 19 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8153814","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":560865611,"identity":"60ba2b11-95b2-47cb-ab5c-f7da847b152c","order_by":0,"name":"Zandile P. Nxumalo","email":"data:image/png;base64,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","orcid":"","institution":"North-West University","correspondingAuthor":true,"prefix":"","firstName":"Zandile","middleName":"P.","lastName":"Nxumalo","suffix":""},{"id":560865613,"identity":"d9fb6600-88b7-4131-9a8c-2ac2cd4062b0","order_by":1,"name":"Nokwanda E. Bam","email":"","orcid":"","institution":"North-West University, North-West University","correspondingAuthor":false,"prefix":"","firstName":"Nokwanda","middleName":"E.","lastName":"Bam","suffix":""},{"id":560865615,"identity":"b0d0096a-1bf2-4b87-98ca-7ab8dcb5c76a","order_by":2,"name":"Khumoetsile D. Shopo","email":"","orcid":"","institution":"North-West University, North-West University","correspondingAuthor":false,"prefix":"","firstName":"Khumoetsile","middleName":"D.","lastName":"Shopo","suffix":""}],"badges":[],"createdAt":"2025-11-19 10:08:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8153814/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8153814/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98390735,"identity":"b794fac4-f0d9-4e92-99c2-2ac53be5d170","added_by":"auto","created_at":"2025-12-17 09:27:12","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":66502,"visible":true,"origin":"","legend":"","description":"","filename":"ZPNxumaloManuscriptBMC.docx","url":"https://assets-eu.researchsquare.com/files/rs-8153814/v1/34b8d1a3b5a25f98aefa4fbf.docx"},{"id":98441296,"identity":"6d465631-4392-403f-9db6-7af9ddc31400","added_by":"auto","created_at":"2025-12-17 17:05:09","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6356,"visible":true,"origin":"","legend":"","description":"","filename":"e272ac8bae2d4672806ffae5406bf5d0.json","url":"https://assets-eu.researchsquare.com/files/rs-8153814/v1/1c128312edc20cf86379681b.json"},{"id":98390734,"identity":"05afdf83-69e7-4cfd-867d-4ebcc402a616","added_by":"auto","created_at":"2025-12-17 09:27:12","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":129729,"visible":true,"origin":"","legend":"","description":"","filename":"e272ac8bae2d4672806ffae5406bf5d01enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8153814/v1/457fe1e9a92e61b4ca9fcf73.xml"},{"id":98390736,"identity":"eb859b1b-9633-49ca-9e81-d78790300a02","added_by":"auto","created_at":"2025-12-17 09:27:13","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":126624,"visible":true,"origin":"","legend":"","description":"","filename":"e272ac8bae2d4672806ffae5406bf5d01structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8153814/v1/45ca32c08974563320c0a704.xml"},{"id":98440656,"identity":"6496338a-92cf-46a6-9b7e-3bd71c7e9527","added_by":"auto","created_at":"2025-12-17 17:04:09","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":141766,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8153814/v1/b168d7324c6e90e087767bce.html"},{"id":98445654,"identity":"e0cf6baf-e9bb-4627-ad5a-3b07d38084b7","added_by":"auto","created_at":"2025-12-17 17:20:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":925770,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8153814/v1/faf27a11-4d10-4001-9fd0-b09858d88dd2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eExperiences of pregnant women diagnosed with gestational diabetes mellitus in the context of HIV/AIDS in the uGu District of KwaZulu-Natal Province. A qualitative study\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eGestational diabetes mellitus is a type of hyperglycemia that starts when a woman is pregnant, making it difficult for her body to control blood glucose levels [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. GDM is associated with several health problems for both the baby and the mother. It results in gestational hypertension (GHPT), preeclampsia and an increased risk of developing type 2 diabetes later in the future for the mother, whereas for the baby, GDM can result in the baby growing larger than normal, which is known as macrosomia [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The baby might have breathing problems at birth and an increased likelihood of developing type 2 diabetes in the future [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. GDM is a global health concern affecting millions of women, with an estimated prevalence of 16% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In Southeast Asia, Africa is the second highest contributor to GDM cases among pregnant women worldwide [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSouth Africa (SA) is reported to have the highest prevalence of diabetes cases in Africa [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The GDM rates in South Africa are between 1.6% and 25.8%, depending on the diagnostic strategies used, but few data exist [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Approximately 3% of SA women of mixed backgrounds were reported to have GDM in the Western Cape; in rural Limpopo, 8.8% of black women had GDM according to the WHO 1999 guidelines, while a prevalence of GDM of 25.8% was observed among black women residing in Gauteng Province [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In KwaZulu-Natal (KZN), where this study took place, there is a 1.6% prevalence of Indian women and 20% prevalence of women of mixed ethnicity with a background of GDM, according to the 1999 WHO guidelines [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Most studies have shown that more HIV-infected mothers develop GDM, but the reasons for this are still unknown [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGDM and HIV/AIDS are two significant health concerns that disproportionately affect pregnant women [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In SA, many people are affected by both HIV and diabetes, especially in KZN [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. It is not well understood how common diabetes is among people living with HIV in KZN or what causes it [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The FDA has informed doctors that PI can increase blood glucose levels and lead to diabetes in patients with HIV [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The FDA stated that the advantages of these drugs are greater than any possible problems, and four approved PIs, saquinavir, indinavir, ritonavir, and nelfinavir, carry the same potential side effects of insulin resistance [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The coexistence of GDM and HIV/AIDS in pregnant women poses an increased risk of adverse maternal and fetal outcomes, which include preterm labor, stillborn, neonatal hypoglycemia, delivery via cesarean section, and obesity.\u003c/p\u003e \u003cp\u003eAccording to a scoping review conducted in sub-Saharan Africa, after HIV-positive pregnant women were informed that they had hyperglycemia, they were shocked, upset, and occasionally refused to believe it [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Moreover, they experienced feelings of fear, remorse, and a loss of control over their everyday lives [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. According to Arias-Colmenero and colleagues [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], 33.33% of Spanish articles about pregnant women's experiences and attitudes following an HIV/AIDS diagnosis mentioned feelings of sadness, disappointment, and loneliness because of ignorance of the virus, which led to social isolation and depression.\u003c/p\u003e \u003cp\u003eSimilarly, Ogueji and colleagues [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] reported that pregnant women experienced anxious concerns about infecting their unborn babies, whereas others worried more about their future life and not so much about their pregnancy. Research has revealed that GDM can make pregnancy more stressful. The psychological and emotional burden of managing GDM, coupled with concerns about babies\u0026rsquo; health, can exacerbate feelings of stress and anxiety in pregnant women [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother research study conducted in Australia by Devsam et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] revealed that women not only had negative feelings and thoughts but also faced challenges in managing GDM. They felt that their identity changed from healthy to having GDM. They had to adapt to these changes while worrying about the health of their babies and themselves, and they feared the seriousness of GDM and developing type 2 diabetes [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Furthermore, research indicates that women with GDM often face stigma and discrimination, which may negatively impact their physical and mental well-being [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Despite the increasing prevalence of GDM and HIV/AIDS among women with these conditions in resource-constrained settings such as the UGu District, there is a lack of comprehensive understanding of their experiences in the literature [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The researcher in the present study argues that exploring the lived experiences of pregnant women with GDM and HIV is as important as studying the pathophysiology of these conditions, as exploring the experiences of these women can help healthcare providers adopt a more holistic and empathetic approach to care. Understanding their experiences and challenges enables healthcare providers to deliver more empathetic and patient-centered care.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eRESEARCH AIM\u003c/h2\u003e \u003cp\u003eThis study aimed to explore and describe the experiences of pregnant women diagnosed with GDM and HIV/AIDS in the UGu District, with the goal of identifying new challenges and recommendations for improving the outcomes of GDM during pregnancy and beyond.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSTUDY DESIGN\u003c/h3\u003e\n\u003cp\u003eA qualitative exploratory-descriptive and contextual research design was employed in this study via semi structured face-to-face individual interviews. An exploratory-descriptive design was chosen to explore and provide an in-depth explanation of the phenomenon, detect recurring patterns and gain meaningful insight. The researcher adopted a contextual research design to provide an in-depth understanding of the experiences of women with GDM after their diagnosis and how these experiences are shaped by their social, cultural, and environmental context. This study was informed by a constructivist approach, which recognizes that individuals construct their knowledge on the basis of personal experiences and that reality may be experienced differently by different people. To analyze the data, according to Braun \u0026amp; Clarke [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], thematic analysis was used alongside ATLAS.ti software.\u003c/p\u003e\n\u003ch3\u003eSTUDY SETTING\u003c/h3\u003e\n\u003cp\u003eThis research study was conducted in KZN, one of nine provinces in SA, with an estimated population of 12.4\u0026nbsp;million. It was conducted in a district known as the uGu District, which is made up of four local towns: Umdoni, Umzumbe, Ray Nkonyeni, and Umuziwabantu [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The area has one regional hospital, three district hospitals, two community health centers and one specialized hospital. This study was specifically conducted in Umdoni Local Municipality in a district hospital that has the greatest number of pregnant women with the phenomena under study compared with the other two district hospitals in the UGu District, making it a relevant and data-rich setting for examining the experiences of pregnant women with dual conditions. Second, the selected district hospital is characterized by limited access to specialized maternal healthcare services, which underscores the need to explore the research topic. The study was conducted in both the ANC clinic and postnatal ward in a healthcare facility.\u003c/p\u003e\n\u003ch3\u003eRECRUITMENT AND SAMPLING\u003c/h3\u003e\n\u003cp\u003eRecruitment of participants started only after ethical approval was received from the North‒West University Health Research Ethics Committee (NWU-HREC), the KZN Department of Health, and goodwill permission from the health facility where the study was conducted. Participants were recruited from the Hospital Antenatal Clinic (ANC), where they attend their routine visits and where the diagnosis of GDM usually occurs, and from the postnatal ward. This hospital facility is reported to have the highest burden of pregnant women receiving HAART and who are diagnosed with GDM [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The mediator (an individual who facilitates communication and coordination between the researcher and potential participants [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]) used the recruitment flyers provided by the researcher to recruit participants who meet the inclusion criteria and represent the target population. The mediator worked together with an independent person (an individual who does not have a direct role in the research study and can provide an objective perspective [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]) to identify pregnant women living with both HIV and GDM and invited them to participate in the study. The researcher contacts the independent person to schedule meetings to meet the prospective participants, liaising closely with the mediator, who knows the appointment dates for the prospective participants. The information sessions at the facility comprise the title of the research; the purpose, aim, objective, and significance of the study; and discussions about the consent form and its contents prior to signing the ethical principles and what they entail and how these affect prospective participants. Upon completion of the information session, the researcher and independent person gave the prospective participants at least 48 hours to consider participation. Upon agreeing, they were given an informed consent form to sign in the presence of a witness of their choice.\u003c/p\u003e\n\u003ch3\u003eDATA COLLECTION\u003c/h3\u003e\n\u003cp\u003eSemi structured individual face‒to-face interviews were used to collect the data for this study [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. A flexible interview schedule was designed prior to the interviews and comprised three main questions and probing questions. The advantage of using face-to-face individual interviews enabled the researcher to explore the lived experiences and perceptions of pregnant women after receiving a diagnosis of GDM. They are also helpful in discussing sensitive topics because people usually feel more comfortable sharing in an individual face-to-face conversation than in a group [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Data collection for this study took two weeks. Data were collected during the last week of April 2025 until the end of the first week of May 2025. The participants were aged between 20 and 44 years. The researcher requested a consultation room/space that was private and free from noise, and the \u0026ldquo;Do not disturb\u0026rdquo; sign was put on the door once the interviews were ongoing so that no one would disturb the session. To ensure comfort, the researcher ensured that the room had proper lighting, good ventilation, comfortable seating, and available water. Privacy and confidentiality were observed throughout the process. The interviews lasted approximately 15\u0026ndash;30 minutes, which was sufficient for exploring the participants\u0026rsquo; insights into the topic. As the interviews progressed, no new information was received from the thirteen (n\u0026thinsp;=\u0026thinsp;13) participants, and data saturation was reached. However, two more participants were interviewed to ensure that data saturation was reached; thus, fifteen (n\u0026thinsp;=\u0026thinsp;15) participants were interviewed.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDATA ANALYSIS\u003c/h2\u003e \u003cp\u003eAn inductive thematic analysis using Braun and Clarke six steps of data analysis was employed to analyze the data in this study [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The ATLAS.ti software was also used for thematic analysis and coding, which were complimentary and thus condensed into the current results. The six phases of thematic analysis include becoming familiar with the data, generating initial codes, generating themes, reviewing potential themes, defining and naming themes, and producing the report. These six phases and software analysis are explained below in terms of how they were followed to analyze the data.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStep 1: Familiarize yourself with the data\u003c/h3\u003e\n\u003cp\u003e In this phase, the researcher carefully transcribed the data word-for-word by listening to the recorded interviews of the participants and repeatedly captured the participants exact responses. Following transcription, the data were read carefully and repeatedly while the audio recordings were crosschecked for consistency and becoming familiar with the content of the data. Additionally, the transcribed data were sorted, and patterns emerged during the transcription process.\u003c/p\u003e\n\u003ch3\u003eStep 2: Generate initial codes\u003c/h3\u003e\n\u003cp\u003eThe researcher coded the data after attending a coding session with a coding expert to promote accuracy and minimize bias. The researcher also had a co-coding and consensus discussion with the two supervisors, who were the co-coders, to increase the credibility of the research study. The first codes were produced from the transcribed data and thereafter worked systematically through the entire dataset, attending to each data item with equal consideration. Interesting aspects of the data items that might be informative in developing themes were identified.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStep 3: Generating for themes\u003c/h2\u003e \u003cp\u003eThrough repeated reading and organizing of the data obtained, the researcher grouped related information into clusters to identify emerging themes and subthemes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStep 4: Reviewing potential themes\u003c/h2\u003e \u003cp\u003eThis step is essentially about quality checking; the researcher checked if the generated themes or subthemes from the participants\u0026rsquo; data were functional and if they provided information that addressed the research question. Themes were cross-checked against the transcript to ensure consensus and accuracy of the dataset.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStep 5: Defining and naming themes\u003c/h2\u003e \u003cp\u003eResearcher have examined the data that have been grouped into themes and subthemes and then assigned each group a name that reflects their meaning. A consensus discussion was held with the supervisors to confirm the themes that emerged.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStep 6: Producing the report\u003c/h2\u003e \u003cp\u003eIn this step, the researcher outlined the results of different themes and subthemes in a final report. The report was compiled in the form of tables and figures to illustrate the themes and findings while ensuring that the report was aligned with the study methodology and research question. The report was reviewed by the two supervisors, who were the co-coders, to confirm that the results were presented truthfully without bias and in a manner that enhanced the confirmability of the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eATLAS.ti\u003c/h2\u003e \u003cp\u003eATLAS.ti software was used after the researcher analyzed the data manually, using six phases of thematic analysis. The researcher uploaded the transcribed data document to the ATLAS.ti system. She then read through the transcribed data and made initial memos or comments and began to develop a feeling of patterns in the data. Codes were created from the patterns noted in the data and were applied to text segments across all the documents. The researcher created codes inductively. Related codes were grouped into code families or categories that presented themes, and related subthemes were grouped under their main themes. The researcher then combined all the findings into a written report, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below. The results generated via ATLAS.ti software were similar to the results obtained when the data were analyzed manually.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e A total of fifteen (n\u0026thinsp;=\u0026thinsp;15) participants were interviewed using semi structured individual face‒to‒face interviews over a period of two weeks. The participants\u0026rsquo; ages ranged from 20\u0026ndash;44 years. The interviews covered several aspects of GDM and HIV/AIDS; to facilitate comprehension of GDM, the terminology had to be changed to \u0026ldquo;sugar in blood\u0026rdquo; (as it was the term known to most of the participants), which was used while interviewing them. Several themes emerged from the data and are reported below, with participants\u0026rsquo; quotes presented to support the themes.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eTHEMES\u003c/h2\u003e \u003cp\u003eSeven major themes emerged from the analysis, notably emotional response, support systems, management strategies, education and awareness, coping mechanisms and healthcare recommendations, followed by several subthemes, as outlined in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below. These themes and subthemes are discussed below, together with supporting data.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of themes and subthemes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubthemes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Emotional response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.1 Fear and anxiety\u003c/p\u003e \u003cp\u003e1.2 Acceptance and resilience\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Support systems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.1 Family support\u003c/p\u003e \u003cp\u003e2.2 Healthcare provider support in health facility\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Management strategies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.1 Dietary changes and exercise\u003c/p\u003e \u003cp\u003e3.2 Medication adherence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Education and awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.1 Older-person condition\u003c/p\u003e \u003cp\u003e4.2 Need for increased awareness\u003c/p\u003e \u003cp\u003e4.3 Peer support and group education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Coping mechanisms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.1 Information-seeking behavior\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Healthcare recommendations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.1 Nurses as healthcare providers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1: Emotional response\u003c/h2\u003e \u003cp\u003e The participants described a range of emotional reactions following their initial diagnosis with GDM. Two subthemes emerged, namely, fear and anxiety and acceptance and resilience.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eFear and anxiety\u003c/h2\u003e \u003cp\u003eThe initial reaction to the diagnosis of GDM for many participants was marked by fear, sadness, and uncertainty about the potential consequences of GDM for both themselves and their unborn child. This was particularly evident among those who had limited prior knowledge of the condition. For example, one participant stated,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I was scared because at that time, I didn\u0026rsquo;t know more about what GDM was and if me and my unborn baby are going to be fine\u0026rdquo;\u003c/em\u003e (P12, 38 years old).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSimilarly, another expressed deep concern:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I was very sad after finding out about my diagnosis because at first the concept GDM was new to me, so I didn\u0026rsquo;t know if me and my unborn baby were going to die\u0026rdquo;\u003c/em\u003e (P6, 33 years old).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eAcceptance and resilience\u003c/h2\u003e \u003cp\u003eOver time, many participants demonstrated a shift from distress to acceptance, often facilitated by counseling and support from healthcare professionals. For example, one participant explained,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I was scared when I was informed that I had GDM, but I ended up accepting after receiving counseling, the nurse explained the condition very well, and she allayed my anxiety.\u0026rdquo;\u003c/em\u003e (P15, 27 years old).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eOthers reframed their diagnosis as a manageable challenge, as in one participant\u0026rsquo;s account:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;After being diagnosed, I had no choice but to accept it because I believe that the first thing to do is acceptance before even taking the medication.\u0026rdquo;\u003c/em\u003e (P4, 34 years old).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eOverall, the trajectory from fear and anxiety to acceptance and resilience suggests that while an initial GDM diagnosis can trigger emotional distress, targeted health education and psychosocial support can facilitate positive adjustment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: Support system\u003c/h2\u003e \u003cp\u003eThe participants reported that they received strong emotional and practical support from family members and healthcare providers, which enabled them to cope better with GDM. The support included dietary adjustments made by family members and ongoing counseling from healthcare professionals. Two subthemes emerged: family support and healthcare provider support in health facilities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eFamily support\u003c/h2\u003e \u003cp\u003eA recurring theme was the contribution of family to offering emotional and practical support. The participants noted that their families often adjusted their diets and routines to accommodate their needs. For example, one participant stated,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eMy support structure is very good because the food I need to avoid eating during these nine months is not present in my home. Everyone is involved in healthy eating; I am not doing it by myself\u0026rdquo; (P1, 34 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAnother participant echoed:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eMy family support me emotionally mostly, and they are considerate when I visit them; they change their diet to accommodate me; we all eat healthy together\u0026rdquo; (P2, 35 years old)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSimilarly, another participant stated the following:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eMy family supports me financially, and they are considerate. They can change the way they eat in order to accommodate me\u0026rdquo; (P14, 41 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eHealthcare provider support in health facilities\u003c/h2\u003e \u003cp\u003eThe participants highlighted the importance of supportive healthcare providers at healthcare facilities who offered counseling and health education about managing GDM. Many patients were reassured by the information and guidance provided by these healthcare providers. The support that was received from the healthcare providers was expressed by the participants as follows:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eThe support I receive from healthcare providers is counseling. They make sure that they gave me counseling after being diagnosed, and they explained in-depth about the disease\u0026rdquo; (P10, 30 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAnother participant reflected:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eThe support I receive from the health providers is mostly information about the condition and advice on how to ensure that I manage the condition, so it doesn\u0026rsquo;t affect my health\u0026rdquo; (P8, 36 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eA strong support system comprising both family and healthcare providers plays a significant role in enhancing the physical and emotional health of pregnant women with HIV and GDM. This integrated support system not only improves maternal and fetal health outcomes but also mitigates the psychosocial burden associated with managing dual health conditions during pregnancy.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: Management strategies\u003c/h2\u003e \u003cp\u003eThe participants noted the importance of incorporating a healthy lifestyle in managing their condition to prevent complications. Responses to this theme revealed the effective management of GDM, focusing on dietary changes, regular exercise, and adherence to medication, which are the subthemes that emerged from this theme and are discussed below with participant codes.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eDietary changes and exercise\u003c/h2\u003e \u003cp\u003eA common pattern was the emphasis on dietary management and exercise as a primary strategy for controlling GDM. The participants discussed the importance of eating balanced meals, avoiding high-sugar foods, and maintaining regular mealtimes. For example, one participant stated,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eDiet is my number one other than medication. If I can control my blood glucose well now using diet, eating well-balanced meals, and exercising, I don\u0026rsquo;t have to put my body and the baby in all the stress of taking medication\u0026rdquo; (P1, 34 years old).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSeveral participants shared the following:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;There is nothing more to do than eating a healthy and well-balanced diet, exercising more often and drinking lots of water at least eight glasses a day\u0026rdquo; (P2, 35 years old; P14, 41 years old; P15, 27 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eMedication adherence\u003c/h2\u003e \u003cp\u003eThe participants also recognized the necessity of adhering to prescribed medications when dietary changes alone were insufficient. They expressed concerns about becoming dependent on medication but acknowledged its importance in managing their condition. Participant 1 mentioned the following:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eIf I can control my blood glucose well now using diet, eating a well-balanced meal I don\u0026rsquo;t have to put my body and the baby in all the stress of taking medication because should I start taking medication now my body will become dependable and it\u0026rsquo;s going to be a problem\u0026rdquo; (P1, 34 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe same participant further explained:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Additionally, they must find other ways of managing the condition before rushing into medication because there are side effects of medication, and one can be dependent on them so they must come up with better solutions such as herbal solutions or dietary solutions and exercises and not just jump into medication\u0026rdquo; (P1, 34 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAnother participant added:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eTaking medication on time and as instructed by the nurses is important to manage the condition and eliminate the health risk that might come with not taking treatment as prescribed\u0026rdquo; (P3, 34 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eEffectively managing both HIV and GDM during pregnancy necessitates a comprehensive strategy focused on lifestyle modification and medication adherence. Implementing tailored dietary plans, encouraging regular exercise, and ensuring consistent treatment adherence are critical components that contribute to maternal metabolic control and viral suppression.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eTheme 4: Education and awareness\u003c/h2\u003e \u003cp\u003e Most participants understood the concept of GDM as \u0026ldquo;sugar in blood\u0026rdquo; and had little knowledge of it. Although they were somewhat familiar with diabetes to some extent, they lacked an in-depth understanding of it, as they thought that the condition only affects older people. Three subthemes emerged from this theme: older person condition, need for increased awareness, and peer support and group education.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eOlder-person condition\u003c/h2\u003e \u003cp\u003eSome participants did not know that diabetes can occur during pregnancy, as they associated it with an older person\u0026rsquo;s condition, as reflected in the following quotes:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eWhat I know about GDM is that it is dangerous and affects older people. A person with GDM must eat every hour because if not the person gets weak.\u0026rdquo; (P12, 38 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAn additional participant openly expressed the following:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eI don\u0026rsquo;t know what GDM is, but I always hear about it; they say it is a deadly condition that usually occurs in older people most of the time\u0026rdquo; (P5, 27 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eNeed for increased awareness\u003c/h2\u003e \u003cp\u003eMany participants called for more awareness campaigns about GDM, particularly in ANC settings, as they are well informed about HIV/AIDS during pregnancy. They felt that better education could alleviate fears and misconceptions surrounding GDM during pregnancy. One participant stated:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;What I know is that when someone has GDM, he or she will develop a wound that will not heal, and the wound will ooze pus then lead to amputation, I do not truly know what GDM does during pregnancy beside amputation\u0026rdquo; (P3, 34 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAnother participant noted what she knew about GDM:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eWhat I know is that GDM is deadly, it can kill, it can happen that when time goes by you get amputation, it can be in your leg or in your hand\u0026rdquo; (P4, 34 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eWhile for HIV/AIDS in pregnancy, the participants reflected that they were aware of the condition, for example, participant 1, a 34-year-old, stated:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eHIV/AIDS is a condition that can spread from person to person through unprotected sex, having a needle prick of an infected person, if you are pregnant and you take your medication well and never skip a day you will not infect your unborn child, so it is important to adhere to HIV treatment when you are pregnant.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAnother participant further explained that:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;HIV/AIDS is like GDM. It is also found in the blood, but it can be spread from mom to baby if the mom is not taking medication well\u0026rdquo; (P2, 35 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSimilarly, other participants explained the following:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;HIV/AIDS is a disease that affects the body\u0026rsquo;s immune system, and it can be spread from person to person in various ways, such as unprotected sex. During pregnancy, the mother must take her medication every day on time to lower the chances of passing the virus to the unborn child\u0026rdquo; (P3, 34 years old; P4, 34 years old; P5, 27 years old; and P6, 33 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePeer support and group education\u003c/h3\u003e\n\u003cp\u003eSome participants suggested the creation of support groups for women with GDM, emphasizing the benefits of sharing experiences and coping strategies. For example, one participant stated:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eThey should do more awareness campaigns on what gestational diabetes is because we have more awareness on what diabetes is but in regard to GDM it\u0026rsquo;s just general; there is no emphasis on it\u0026rdquo; (P1, 34 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAnother participant stated:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003ehave/create support groups for women with these conditions, so they can encourage each other and remind each other of the time to medication, ensuring that everyone is okay\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eNurses must teach us more about conditions that can occur or happen to us during pregnancy, how to prevent them or how to manage the condition we already have them. Give more health education about these conditions\u0026rdquo; (P7, 20 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFurthermore, another participant reiterated:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eThey must give us more health education about these types of conditions and let it be an ongoing thing and not only educate us after diagnosis they must also offer counseling more often not after being diagnosed only so that we can be more informed and confident about the disease\u0026rdquo; (P12, 38 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIncreasing education and awareness is essential for supporting pregnant women living with both HIV and GDM. Increased awareness, peer support and group education not only enhance understanding and adherence to care but also help reduce stigma and isolation, empowering these women through targeted educational initiatives designed to promote better health outcomes for both mothers and their babies.\u003c/p\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003eTheme 5: Coping mechanisms\u003c/h2\u003e \u003cp\u003eThe participants in this theme revealed what they did initially after being diagnosed with GDM, which led them to be able to cope, live with and manage the condition. One subtheme emerged from this theme, namely, information-seeking behavior.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eInformation-seeking behavior\u003c/h2\u003e \u003cp\u003eThe participants often sought additional information about GDM through research and consultations with healthcare providers. This proactive approach helped them feel more in control of their health.\u003c/p\u003e \u003cp\u003eParticipant 2, 35 years old, mentioned the following:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cb\u003eI\u003c/b\u003e attended counseling, which helped me a lot and gave me more information about the condition.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSimilarly, another participant remarked:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eI went on and sought more information by asking the nurse what the condition is and how can I manage and protect myself and my unborn child\u0026rdquo; (P5, 27 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAnother participant mentioned:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eI went on and sought more information about GDM just to gain more insight into the condition; then, it was easy for me to accept and start doing the exact things the nurses said I must do\u0026rdquo; (P4, 34 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eA final perspective came from the participant, who stated the following:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I went on and sought more information about the condition of what it is and how I can protect or prevent it from becoming complicated and affecting my health\u0026rdquo; (P9, 26 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSeeking information emerged as a critical coping mechanism for pregnant women diagnosed with both HIV and GDM. By proactively acquiring knowledge, these women were able to gain a clearer understanding of their situation, follow treatment plans more effectively, interact more confidently with healthcare providers and be able to make informed decisions throughout pregnancy.\u003c/p\u003e \u003cdiv id=\"Sec33\" class=\"Section3\"\u003e \u003ch2\u003eTheme 6: Healthcare recommendations\u003c/h2\u003e \u003cp\u003e The participants emphasized the need for healthcare workers to be approachable, maintain patient confidentiality, and be open and understanding. One subtheme emerged from the main theme, namely, \u0026ldquo;Nurses as healthcare providers,\u0026rdquo; and is discussed below.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec34\" class=\"Section3\"\u003e \u003ch2\u003eNurses as healthcare providers\u003c/h2\u003e \u003cp\u003eTo support this theme, one participant stated:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eNurses must be professional; they must not disclose one patient\u0026rsquo;s information to another patient. Like other nurses after you leave the consultation, he/she will talk about you to the next patient\u0026rdquo; (P5, 27 years old).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAnother participant further explained:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Nurses must not be rude, they must speak well with patients and not always threaten them by telling them that if they don\u0026rsquo;t do what they tell them they will die, they must not make patients scared but speak to them in a manner that they will understand and not be scared to ask or answer questions asked\u0026rdquo; (P8, 36 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAnother participant reflected that:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Nurses must treat us exactly like everyone else don\u0026rsquo;t have discrimination because separating us will be the most hurtful thing because the only difference is that we have these diseases\u0026rdquo; (P9, 26 years old; P11, 25 years old).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eNurses play an important role in the delivery of comprehensive care and education to pregnant women who have both HIV and GDM. Strengthening their involvement through targeted training and supportive policies enhances patient outcomes, improves care continuity and fosters trust in pregnant women. They serve as frontline healthcare providers and are instrumental in delivering holistic, patient-centered care to pregnant women. Their role extends beyond clinical management to include education, emotional support, and advocacy.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis exploratory-descriptive and contextual study provides a better understanding of the lived experiences of pregnant women diagnosed with GDM and HIV/AIDS. Like the other qualitative findings discussed below, this study produced valuable data on pregnant women\u0026rsquo;s experiences living with both GDM and HIV/AIDS. To the best of our knowledge, this study is the first in the uGu District of KZN to reveal the lived experiences, thoughts and feelings of pregnant women with these comorbid conditions. Six main themes and 11 subthemes were obtained from coding this study and are discussed below.\u003c/p\u003e \u003cp\u003eThe diagnosis of GDM represented a traumatic turning point for the participants in this study, triggering strong emotions that align with prior studies [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The results of this study revealed that when HIV/AIDS pregnant women were first diagnosed with GDM, they experienced many negative thoughts, stress, anxiety and fear concerning the health and safety of their unborn baby. Similar findings were noted in a review examining women\u0026rsquo;s experiences with a GDM diagnosis, highlighting that being diagnosed with a health condition such as GDM can adversely influence a pregnant woman\u0026rsquo;s quality of life due to fears regarding the possibility of the illness affecting her and/or her baby [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. A concurrent outcome was found in a qualitative study performed in western Turkey, which revealed that pregnant women who were diagnosed with GDM and HIV were concerned about the potential effect on their unborn children. They fear that their babies will be born with the conditions [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Other researchers have noted that although the initial diagnosis of GDM can cause significant anxiety in pregnant women, this anxiety may not last long [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In this research study, this appeared to be the case for some pregnant women, as they mentioned that they were scared and anxious at first, but they later accepted the diagnosis. This study revealed that recognizing how pregnant women with HIV feel about GDM diagnosis is important for developing suitable interventions and enhancing their care throughout their pregnancy journey.\u003c/p\u003e \u003cp\u003eAnother key finding of this study is that the family plays a significant role in providing emotional and practical support. The participants in this study reported that their families often adjusted their diets and routines to accommodate their needs. A contemporaneous qualitative study on perceived needs in women with GDM indicated that support from family members and friends effectively affected the participants\u0026rsquo; decision to choose healthier lifestyles. Support encourages pregnant women to believe that they are well cared for, whereas a lack of support makes pregnant women feel more vulnerable and that their friends and family members have abandoned them [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, the results of this study highlight the importance of supportive healthcare providers at healthcare facilities who offer counseling and education about managing GDM. Many participants were reassured by the information and guidance provided by nurses. These findings are in line with those of prior studies, highlighting that customized education and compassionate communication from healthcare providers greatly enhance self-care practices and glycemic management in pregnant women living with GDM [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. A narrative review study also revealed that interventions conducted by healthcare professionals, particularly nurses offering informational, motivational, and emotional assistance, resulted in improved self-care practices, better glycemic regulation, and increased self-efficacy in women with GDM [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The findings from a case‒control study conducted in Ankara, Turkiye emphasized that organized diabetes education programs provided by nurses and multidisciplinary teams were associated with improved glycemic control, reduced weight gain during pregnancy, and lower insulin requirements among women diagnosed with GDM [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Our results align with a robust body of literature showing that healthcare providers who are supportive and focused on patients\u0026rsquo; needs by offering personalized counseling, organized education, and continual emotional assistance significantly enhance self-management and good pregnancy outcomes in HIV-positive pregnant women with GDM.\u003c/p\u003e \u003cp\u003eThe results of this study also revealed the effective management of GDM, with a focus on dietary changes, regular exercise and adherence to medication. The participants noted the importance of a healthy lifestyle in managing their condition and preventing complications. A common pattern was the emphasis on dietary management and exercise as a primary strategy for controlling GDM. The participants discussed the importance of eating well-balanced meals and exercising frequently to manage their condition. Unsurprisingly, pregnant women valued managing their diabetes and understood its significance for both their well-being and that of their babies. Smyth and colleagues [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] reported similar results, emphasizing that diet and exercise are the cornerstones of GDM management. Another comparable phenomenological study on insulin use in GDM highlighted that pregnant women affected by GDM may first follow a healthy diet and exercise plan on the basis of their body weights [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Similarly, the ADA recommends that nutrition therapy and physical activity interventions be used as first-line treatments for the management of GDM [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. However, women reported that the diagnosis increased their responsibility because they now had to take extra precautions concerning their dietary regimens [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe participants in this study also recognized the need to adhere to prescribed medications when dietary changes alone were insufficient. They expressed concerns about becoming dependent on medication but acknowledged its importance in managing their condition. A recent literature review on GDM conducted in Poland by Modzelewski et al. [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] further explained that when the basic method of managing GDM is inadequate, pharmacotherapy can be used to intensify treatment, such as insulin, glibenclimide and metformin, but insulin therapy is usually used [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. This finding aligns with the results of a comprehensive review by Nakshine and Jogdand [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], which highlighted that pharmacotherapy can be an option in patients whose blood glucose level cannot be managed with a well-balanced diet and lifestyle modification.\u003c/p\u003e \u003cp\u003eThe results of this study demonstrated that knowledge about GDM is insufficient. Out of the 15 participants in this study, ten (n\u0026thinsp;=\u0026thinsp;10) participants, accounting for 66.67% of all participants, lacked awareness of GDM. Furthermore, other participants possessed some knowledge of what \u0026ldquo;sugars in blood\u0026rdquo; meant, but they could not relate this condition to GDM. Surprisingly, other participants demonstrated an understanding of what diabetes is, but they were not aware that it could happen during pregnancy, as they mistakenly believed that the condition affected only older persons. These findings are similar to the findings observed in a cross-sectional survey performed in Nigeria by Ogu et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], which revealed that only a limited number of participants possessed excellent knowledge of GDM [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMany participants called for more awareness campaigns about GDM, particularly in ANC settings. They felt that better education could alleviate fears and misconceptions surrounding the condition. One participant emphasized that healthcare workers should conduct more awareness campaigns on what GDM is because they are more aware of diabetes and HIV/AIDS, but in regard to GDM, there is little knowledge sharing. These findings align with the findings from a qualitative systemic review study highlighting that, during the interviews, participants frequently talked about needing more education. Women expressed a need for increased awareness and additional support [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. A lack of adequate information has also been highlighted in other studies [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] as an important factor leading to confusion, frustration and helplessness among pregnant women with GDM.\u003c/p\u003e \u003cp\u003eSome participants suggested the creation of support groups for women with GDM, emphasizing the benefits of sharing experiences and coping strategies. Two of the participants mentioned that it would be beneficial for them if they could have support groups for all pregnant women with these conditions so that they could encourage each other and remind each other of the time to take medication and ensure that everyone is coping. Rice et al. [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] reported that peer support appears to be incredibly important to pregnant women. It improves their overall experience, reduces feelings of isolation, and could be an underutilized resource by healthcare providers. In this study, diabetes during pregnancy was not given much attention because it was seen as a less serious and temporary condition; therefore, more emphasis on GDM is needed in health facilities to increase awareness.\u003c/p\u003e \u003cp\u003eThe participants in this study revealed what they did initially after being diagnosed with GDM, which led them to be able to cope with and live with the condition. They further disclosed what helped them to be able to accept and learn to live and manage their condition, including seeking additional information about GDM through research and consultations with healthcare providers. This proactive behavior helped them feel more in control of their health. Several participants highlighted that they went on and sought more information about GDM to gain more insight into the condition and be well informed about it.\u003c/p\u003e \u003cp\u003eNotably, most women in the current study were able to overcome the initial shock and anxiety following GDM diagnosis and gradually made the necessary adjustments to living with GDM. Their perceived anxiety did not increase as the pregnancy progressed, suggesting that it could be reactive anxiety triggered by the unexpected diagnosis of GDM as opposed to intrinsic anxiety. A concurrent qualitative study on the experiences of women with GDM in Singapore highlighted that, at first, many women experienced a sense of \u0026ldquo;shock\u0026rdquo; regarding the diagnosis of GDM and believed that they did not receive enough information from their healthcare providers. After the diagnosis, they then went ahead and sought additional guidance on their own on the internet and became more knowledgeable about the condition [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. A similar finding in another qualitative research study further suggested that pregnant women reported actively seeking information and guidance to better understand GDM and care [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. These findings demonstrated the importance of prompt and transparent counseling led by healthcare providers during diagnosis to assist pregnant women, especially those dealing with HIV and GDM, in becoming knowledgeable, self-assured, and empowered in taking charge of their health.\u003c/p\u003e \u003cp\u003eThe findings of this study also emphasized the need for healthcare workers to be approachable, open, and friendly and to maintain patient confidentiality. Several participants highlighted that healthcare providers had to maintain confidentiality at all times during the interviews. They had to communicate well with them and not speak to them in a manner that would prevent the patient from sharing when they are not feeling well or having any problems. Some participants also reported that nurses had to treat them exactly like everyone else and not discriminate against them. Healthcare providers must provide accurate information and maintain women\u0026rsquo;s willingness to attend subsequent ANC visits [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The perceived importance of health professionals in providing information, awareness and support for women with GDM was evident in this study. The impact of healthcare provider‒patient relationships resonated throughout the narrative and is supported by qualitative research describing the importance of health professional support and patient‒provider interactions. Professional health support may also be an important determinant of longer-term health status [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In light of increasing rates of GDM, this will pose a challenge for healthcare providers to adequately support all women diagnosed with GDM both now and in the future [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eSTUDY STRENGHTS AND LIMITATIONS\u003c/h3\u003e\n\u003cp\u003eTo the best of our knowledge, this study is the first to explore and document the lived pregnancy experiences of women concurrently living with HIV and GDM in the UGu District of KwaZulu-Natal. This contributes valuable insight into the limited scholarly discourse on maternal health within resource-constrained settings characterized by a high burden of disease and provides a foundation for subsequent investigations.\u003c/p\u003e \u003cp\u003eA further strength lies in the diversity of participant responses, which enhances the credibility of the findings and indicates a reduced likelihood of response bias. Consistency during data collection was promoted by having all interviews conducted by a single researcher, thereby ensuring uniformity in interviewing style and approach.\u003c/p\u003e \u003cp\u003eDespite these strengths, several limitations should be acknowledged. The study utilized a relatively small and geographically limited sample, which may affect the transferability of the findings to other settings. Furthermore, as the interviews were conducted by a single researcher, the potential for interviewer bias cannot be entirely excluded, despite efforts to maintain neutrality. The self-reported nature of the data may also be subject to recall or social desirability bias. Finally, the cross-sectional design limits the ability to capture changes in experiences over time.\u003c/p\u003e \u003cp\u003eNevertheless, many of the predefined themes were brought up by the women themselves to achieve the research objectives, and follow-up questions were often used to confirm or refute the relevance of those themes in the overall project.\u003c/p\u003e \u003cdiv id=\"Sec37\" class=\"Section2\"\u003e \u003ch2\u003eIMPLICATION FOR PRACTICE\u003c/h2\u003e \u003cp\u003eThe results of this study have implications for both future research and nursing practice. They revealed a significant gap in the nursing research literature regarding the lived experiences of pregnant women diagnosed with both HIV and GDM. While research on each condition individually is extensive, there is limited empirical evidence exploring the intersection of these two diagnoses, particularly from a patient-centered perspective. To fill this gap and inform future interventions, more qualitative studies such as this one are needed.\u003c/p\u003e \u003cp\u003eThe results of this research study also highlight significant considerations for nursing practice, specifically in improving the management and treatment of pregnant women living with GDM and HIV. The research findings emphasize key aspects where nursing care can be enhanced to foster better health outcomes for pregnant women and their babies. These include health education, patient communication, emotional support, confidentiality and equitable treatment. One significant finding reveals that there is a deficiency in awareness and health education regarding GDM, both in the general public and within standard ANC services. It is suggested that nurses take an active role in creating and implementing focused health education programs centered around GDM. These programs should be incorporated into ANC to improve awareness of the condition, its associated risk factors and how to manage it effectively. Regular educational sessions can equip women with knowledge, alleviate their anxiety related to the diagnosis and promote compliance.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe findings of this study emphasize that pregnant women with GDM and HIV/AIDS experience a stressful pregnancy journey, as they must deal with the fear and anxiety associated with the possible complications of these two comorbidities. The findings also revealed that these women are very concerned that they may pass the conditions to their unborn child. Although GDM typically resolves after birth, it has long-lasting impacts on pregnant women. Given the increasing frequency of GDM in HIV-infected pregnant women and its various psychosocial effects, the results of this study emphasize the importance for healthcare professionals to recognize not only the consequences of a GDM diagnosis for pregnant women but also their experiences of living with this condition. This study also revealed that it is crucial that pregnant women diagnosed with GDM obtain regular, personalized, evidence-based information along with continuous psychological and social assistance. This qualitative study provides evidence that the clinical care that pregnant women receive can negatively affect their pregnancy experience.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eETHICS APPROVAL AND CONSENT TO PARTICIPATE\u003c/strong\u003e \u003cp\u003e Ethical approval was received from the university, Ethics Number: XXX-00090-24-A1-01, KZN Department of Health, and the goodwill permission from the hospital facility was obtained. Written informed consent was obtained from the participants before the data collection process began.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCONSENT FOR PUBLICATION\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCOMPETING INTEREST\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eAUTHORSHIP CONTRIBUTION STATEMENT\u003c/h2\u003e \u003cp\u003eAll the authors contributed to the conceptualization of the study. ZPN and NEB participated in the study investigation, that is, in enrolling participants and data collection. The analysis was completed by ZPN, who also developed the final coding; NEB and KDS co-coded the data. ZPN wrote the initial manuscript draft, which was critically reviewed and commented on by NEB and KDS. The final version was approved by all the authors.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFUNDING INFORMATION\u003c/h2\u003e \u003cp\u003eThe study is funded by the National Research Foundation (NRF) of South Africa, Thuthuka Project (Grant number: TK23042095297). However, all the opinions, findings, and conclusions are solely those of the authors and are not associated with the NRF in any way.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll the authors contributed to the conceptualization of the study. ZPN and NEB participated in the study investigation, that is, in enrolling participants and data collection. The analysis was completed by ZPN, who also developed the final coding; NEB and KDS co-coded the data. ZPN wrote the initial manuscript draft, which was critically reviewed and commented on by NEB and KDS. The final version was approved by all the authors.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to sincerely thank all the participants who volunteered their time to take part in this research and share their experiences, joy and fears.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Diabetes.. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/diabetes\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/diabetes\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Date of access: 12 Jan. 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBukasa LL, Cortina-Borja M, Peters H, Taylor GP, Thorne C. Gestational diabetes in women living with HIV in the UK and Ireland: insights from population-based surveillance data. Afr J Reprod Gynecol Endoscopy. 2023;26:e26078. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/jia2.26078\u003c/span\u003e\u003cspan address=\"10.1002/jia2.26078\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChebrolu, P., Alexander, M., Bhosale, R., Naik, S., Gupte, N., Lee, M.H., \u0026hellip; Mathad,J.S. The Association of Gestational Diabetes with HIV infection and tuberculosis in Indian women. The American Journal of Tropical Medicine and Hygiene. 2022; 107:569.https://www.ajtmh.org/abstract/journals/tpmd/107/3/article-p569.xml.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaez-de-Ibarra I, Lopez-Gonzalez D, Diaz-Redondo A. Global prevalence of gestational diabetes mellitus: A systematic review and meta-analysis. Diabetes Res Clin Pract. 2022;187:109849. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.diabres.2022.109849\u003c/span\u003e\u003cspan address=\"10.1016/j.diabres.2022.109849\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUmar DM, Naidoo P. Prevalence and predictors of diabetes mellitus among persons living with HIV: a retrospective cohort study conducted in 4 public healthcare facilities in KwaZulu-Natal. BMC Public Health. 2021;21:288. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12889-021-10318-6\u003c/span\u003e\u003cspan address=\"10.1186/s12889-021-10318-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bmcpublichealth.biomedcentral.com/articles/\u003c/span\u003e\u003cspan address=\"https://bmcpublichealth.biomedcentral.com/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDias S, Adam S, Rheeder P, Pheiffer C. Prevalence of and risk factors for gestational diabetes mellitus in South Africa. South Afr Med J. 2019;109:463\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7196/SAMJ.2019.v109i7.14127\u003c/span\u003e\u003cspan address=\"10.7196/SAMJ.2019.v109i7.14127\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuddle KR, MoldMould TA. Gestational diabetes mellitus in a multi-ethnic population in KwaZulu-Natal. South Afr Med J. 2020;110:340\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFalasca K, Ucciferri C, Mancino P, Di Nicola M, Vecchiet J, Manzoli L. Gestational diabetes mellitus in HIV-infected women: A review. J Med Virol. 2020;92:1725\u0026ndash;33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/jmv.25844\u003c/span\u003e\u003cspan address=\"10.1002/jmv.25844\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://onlinelibrary.wiley.com/doi/full/10.1002/jmv.25844\u003c/span\u003e\u003cspan address=\"https://onlinelibrary.wiley.com/doi/full/10.1002/jmv.25844\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNAIDS. UNAIDS data. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.unaids.org/sites/default/files/media_asset/data-book-2022_en.pdf\u003c/span\u003e\u003cspan address=\"https://www.unaids.org/sites/default/files/media_asset/data-book-2022_en.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Date of access: 28 Jul. 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarkar S, Brown TT. \u003cem\u003eDiabetes in people living with HIV\u003c/em\u003e. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK545886/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/books/NBK545886/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Date of access: 20 Jul.2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkinsolu, F.T., Adewole, I.E., Lawale, A., Olagunju, M.T., Abodunrin, O.R., Ola, O.M.,\u0026hellip; Chukwuemeka, A.N. HIV and pregnancy among adolescents in sub-Saharan Africa: A scoping review. medRxiv. 2024;04. https://doi.org/10.1101/2024.04.25.24305581.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArias-Colmenero T, P\u0026eacute;rez-Morente M\u0026Aacute;, Ramos-Morcillo AJ, Capilla-D\u0026iacute;az C, Ruzafa-Mart\u0026iacute;nez M, Hueso-Montoro C. Experiences and attitudes of people with HIV/AIDS: A systematic review of qualitative studies. Int J Environ Res Public Health. 2020;17:639. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph17020639\u003c/span\u003e\u003cspan address=\"10.3390/ijerph17020639\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOgueji IA. Experiences and predictors of psychological distress in pregnant women living with HIV. Br J Health Psychol. 2021;26:882\u0026ndash;901. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/bjhp.12510\u003c/span\u003e\u003cspan address=\"10.1111/bjhp.12510\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCraig L, Sims R, Glasziou P, Thomas R. Women\u0026rsquo;s experiences of a diagnosis of gestational diabetes mellitus: a systematic review. BMC Pregnancy Childbirth. 2020;20:76. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12884-020-2745-1\u003c/span\u003e\u003cspan address=\"10.1186/s12884-020-2745-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDevsam BU, Bogossian FE, Peacoc AS. An interpretive review of women\u0026rsquo;s experiences of gestational diabetes mellitus: Proposing a framework to enhance midwifery assessment. Women Birth. 2013;26:69\u0026ndash;76. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.wombi.2012.12.003\u003c/span\u003e\u003cspan address=\"10.1016/j.wombi.2012.12.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavidsen E, Maindal HT, Rod MH, Olesen K, Byrine M, Damm P. Nielsen. K.K. The stigma associated with gestational diabetes mellitus: Scoping Review. Lancet. 2022;52:10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.eclinm.2022.101614\u003c/span\u003e\u003cspan address=\"10.1016/j.eclinm.2022.101614\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraun V, Clarke V. Reflecting on reflexive thematic analysis. \u003cem\u003eQualitative Research in Sport, Exercise and Health\u003c/em\u003e. 2019. 11(4), 589\u0026ndash;97. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/2159676X.2019.1628806\u003c/span\u003e\u003cspan address=\"10.1080/2159676X.2019.1628806\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartment of Health (South Africa). Referral system: levels of healthcare.. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www2.kznhealth.gov.za/Referral-system.htm\u003c/span\u003e\u003cspan address=\"https://www2.kznhealth.gov.za/Referral-system.htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Date of access: 2 Jun. 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNyasulu, P.S., Ngasama, E, Tamuzi, J.L., Sigwadhi, L.N., Ozougwu, L.U., Nhandara,R.B.C., \u0026hellip; Ayele, B.T. Effect of HIV status and antiretroviral treatment on treatment outcomes of tuberculosis patients in a rural primary healthcare clinic in South Africa.PLoS One. 2022; 17:e0274549.https://doi.org/10.1371/journal.pone.0274549.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlick U. An introduction to qualitative research. 6th ed. London: SAGE; 2020. pp. 140\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeyer S, Naude M, Shangase NC, Van Niekerk SE. The nursing unit management: A comprehensive guide. 3rd ed. South Africa, SA: Pearson (Pty) Ltd; 2022. pp. 47\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUpmetrics Staff. 8 essential qualitative data collection methods.. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://blog.upmetrics.com/essential-qualitative-data-collection-methods\u003c/span\u003e\u003cspan address=\"https://blog.upmetrics.com/essential-qualitative-data-collection-methods\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Date of access:19 Aug. 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026Ouml;ren EDT, Avdal E\u0026Uuml;, Polat G, Sofulu F, D\u0026uuml;zg\u0026uuml;n G, Pamuk G. Experiences of women with gestational diabetes about fear of having diabetes in their babies: A qualitative study. Medicine. 2024;103:e37755. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC11018210/\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC11018210/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorrison MK, Hayes L, Shand AW, Caterson ID. Gestational diabetes mellitus in HIV-positive women: A systematic review and meta-analysis. Diabetes Res Clin Pract. 2020;159:107934. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1016/j.diabres.2020.107934\u003c/span\u003e\u003cspan address=\"10.1016/j.diabres.2020.107934\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuhwava LS, Murphy K, Zarowsky C, Levitt N. Perspectives on the psychological and emotional burden of having Gestational Diabetes amongst low-income women in Cape Town, South Africa. BMC Womens Health. 2020;20:231. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12905-020-01093-4\u003c/span\u003e\u003cspan address=\"10.1186/s12905-020-01093-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhooshehchin TE, Keshavarz Z, Afrakhteh M, Shakibazadeh E, Faghihzadeh S. Perceived needs in women with gestational diabetes: A qualitative study. Electron Physician. 2016;8:3412. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ephysician.ir/2016/3412.pdf\u003c/span\u003e\u003cspan address=\"https://www.ephysician.ir/2016/3412.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaron Z, Sutan R, Zakaria R, Mahdy ZA. Self-care educational guide for mothers with gestational diabetes mellitus: A systematic review on identifying self-care domains, approaches, and their effectiveness. Belitung Nurs J. 2023;9:6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.belitungraya.org/BRP/index.php/bnj/article/view/2396\u003c/span\u003e\u003cspan address=\"https://www.belitungraya.org/BRP/index.php/bnj/article/view/2396\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu N, Han X, Chen S, Zhang J, Gu P. Self-reported barriers in self‐management of women with gestational diabetes: A systematic review of qualitative studies. Nurs Open. 2023;10:7130\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/nop2.1988\u003c/span\u003e\u003cspan address=\"10.1002/nop2.1988\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://onlinelibrary.wiley.com/doi/full/\u003c/span\u003e\u003cspan address=\"https://onlinelibrary.wiley.com/doi/full/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDailah HGJ. The influence of nurse-led interventions on diseases management in patients with Diabetes Mellitus: a narrative review. Healthcare. 2024;12:352. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/healthcare12030352\u003c/span\u003e\u003cspan address=\"10.3390/healthcare12030352\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTopkara S, Soysal \u0026Ccedil;. The effect of diabetes education on maternal and neonatal outcomes in pregnant women diagnosed with gestational diabetes. BMC Pregnancy Childbirth. 2024;24:747. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12884-024-06971-5\u003c/span\u003e\u003cspan address=\"10.1186/s12884-024-06971-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bmcpregnancychildbirth.biomedcentral.com/articles/\u003c/span\u003e\u003cspan address=\"https://bmcpregnancychildbirth.biomedcentral.com/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmyth S, Mulligan K, Rutter E, Harrington L, Hatunic M, Higgins MF. Attitudes of women with gestational diabetes toward diet and exercise: a qualitative study. J Maternal-Fetal Neonatal Med. 2023;36:2155045. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/14767058.2022.2155045\u003c/span\u003e\u003cspan address=\"10.1080/14767058.2022.2155045\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eD\u0026uuml;zg\u0026uuml;n G, Polat G, Avdal E\u0026Uuml;. Perspective on insulin use in gestational diabetes: A phenomenological study. Medicine. 2023;102:e35831. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.lww.com/md-journal/fulltext/2023/12080/perspective_on_insulin_use_in_gestational.74.aspx\u003c/span\u003e\u003cspan address=\"https://journals.lww.com/md-journal/fulltext/2023/12080/perspective_on_insulin_use_in_gestational.74.aspx\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDunne P, O'Mahony L, Culliney L, Byrne M, Murphy AW. O'Reilly, SExploring the lived experience of women with gestational diabetes: A cross-sectional Irish national survey. Diabet Med. 2025;42:e15489. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/dme.15489\u003c/span\u003e\u003cspan address=\"10.1111/dme.15489\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaravasileiadou S, Almegewly W, Alanazi A, Alyami H, Chatzimichailidou S. Self-management and self-efficacy of women with gestational diabetes mellitus: a systematic review. Global Health Action. 2022;15:2087298. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/16549716.2022.2087298\u003c/span\u003e\u003cspan address=\"10.1080/16549716.2022.2087298\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.tandfonline.com/doi/full/\u003c/span\u003e\u003cspan address=\"https://www.tandfonline.com/doi/full/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eModzelewski R, Stefanowicz-Rutkowska MM, Matuszewski W, Bandurska-Stankiewicz EM. Gestational diabetes mellitus \u0026ndash; recent literature review. \u003cem\u003eJournal of Clinical Medicine\u003c/em\u003e. 2022; 11:5736. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mdpi.com/2077-0383/11/19/5736\u003c/span\u003e\u003cspan address=\"https://www.mdpi.com/2077-0383/11/19/5736\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakshine VS, Jogdand SD. A comprehensive review of Gestational diabetes mellitus: impacts on maternal health, fetal development, childhood outcomes, and long-term treatment strategies. Cureus. 2023;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7759/cureus.47500\u003c/span\u003e\u003cspan address=\"10.7759/cureus.47500\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOgu RN, Maduka O, Agala V, Alamina F, Adebiyi O, Edewor U, Porbeni I, Abam C. Gestational diabetes mellitus knowledge among women of reproductive age in southern Nigeria: Implications for diabetes education. Int Q Community Health Educucation. 2019;40:177\u0026ndash;83. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pubmed/31554478\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pubmed/31554478\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Mutawtah M, Campbell E, Kubis HP, Erjavec M. Women\u0026rsquo;s experiences of social support during pregnancy: a qualitative systematic review. BMC Pregnancy Childbirth. 2023;23:782. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12884-023-06089-0\u003c/span\u003e\u003cspan address=\"10.1186/s12884-023-06089-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRice C, Ingram E, O\u0026rsquo;Mahen H. A qualitative study of the impact of peer support on women\u0026rsquo;s mental health treatment experiences during the perinatal period. BMC Pregnancy Childbirth. 2022;22:689. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12884-022-04959-7?utm\u003c/span\u003e\u003cspan address=\"10.1186/s12884-022-04959-7?utm\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bmcpregnancychildbirth.biomedcentral.com/articles/\u003c/span\u003e\u003cspan address=\"https://bmcpregnancychildbirth.biomedcentral.com/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLazarus MA, Lee VV, Ong DLS, Yew TW, Shorey S, Young D, Eriksson JG. Understanding the experiences of women with gestational diabetes in Singapore: A qualitative study. Int J Women's Health. 2025; 1711\u0026ndash;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.dovepress.com/understanding-the-experiences-of-women-with-gestational-diabetes-in-si-peer-reviewed-fulltext-article-IJWH\u003c/span\u003e\u003cspan address=\"https://www.dovepress.com/understanding-the-experiences-of-women-with-gestational-diabetes-in-si-peer-reviewed-fulltext-article-IJWH\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSahu, B., Babu, G.R., Gurav, K.S., Karthik, M., Ravi, D., Lobo, E. \u0026hellip; Kinra, S. Healthcare professionals\u0026rsquo; perspectives on screening and management of gestational diabetes mellitus in public hospitals of South India\u0026ndash;a qualitative study. BMC Health Services Research. 2021; 21:133. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06077-0?utm.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Experience, Gestational diabetes mellitus, highly active antiretroviral therapy, HIV/AIDS, Pregnant women.","lastPublishedDoi":"10.21203/rs.3.rs-8153814/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8153814/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Human immunodeficiency virus (HIV) is an intricate retrovirus that is chronic and incurable. It targets the body's immune system, particularly Cluster of Differentiation 4, a type of white blood cell that helps the immune system fight infections. Pregnant women who are living with HIV/AIDS and have been receiving highly active antiretroviral therapy (HAART), especially the proteaseinhibitor regimen, are at risk of developing gestational diabetes mellitus (GDM). This regimen was deemed sufficient for controlling HIV levels and lowering the chances of passing it from mother to child. However, it hasmany undesirable effects, such astissue insulin resistance. Pregnant women affected by both HIV and GDM often face increased emotional distress and fear that they might pass the conditions to their unborn babies. There is a notable absence of studies on the lived experiences of HIV-positive pregnant women after being diagnosed with GDM in the UGu District of KwaZulu-Natal to support the study. Understanding these lived experiences is important for informing patient-centered care and improving maternal and child health outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA total of fifteen (n=15) pregnant women with both HIV and GDM were purposively selected to participate in the study. Semi structured face‒to-face individual interviews were used to collect data from the participants. Thematic data analysis was conducted via the Braun \u0026amp; Clarke method of analysis and ATLAS.ti software. Ethical considerations and trustworthiness were adhered to.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eSix themes and 11 subthemes arose from the study findings, namely, (1) emotional response – fear and anxiety, acceptance and resilience; (2) support systems – family support, healthcare provider support in health; (3) management strategies – dietary changes and exercise, medication adherence; (4) education and awareness – older-person conditions, need for increased awareness, peer support and group education; (5) coping mechanisms – information-seeking behavior; and (6) healthcare recommendations – nurses as healthcare providers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The findings highlight that pregnant women with GDM and HIV/AIDS experience a stressful pregnancy journey, as they must deal with the fear and anxiety associated with the possible complications of comorbid conditions.\u003c/p\u003e","manuscriptTitle":"Experiences of pregnant women diagnosed with gestational diabetes mellitus in the context of HIV/AIDS in the uGu District of KwaZulu-Natal Province. A qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-17 09:27:02","doi":"10.21203/rs.3.rs-8153814/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-01T04:54:56+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-28T04:20:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"127172464845399962903136990674216906645","date":"2025-12-21T13:22:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"110597010787218636869710319000936509703","date":"2025-12-21T12:54:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-19T19:00:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"328604933449337270200072487326925768681","date":"2025-12-19T17:12:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-19T14:13:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"119526322992437725005798334557801833082","date":"2025-12-18T06:41:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"148373579711115564920078278266410874931","date":"2025-12-14T12:54:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-12T11:57:06+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-21T04:50:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-20T07:05:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-20T07:03:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-11-19T09:52:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d6c0d4a7-1524-422d-a51c-5f84914d3d82","owner":[],"postedDate":"December 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-06T17:39:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-17 09:27:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8153814","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8153814","identity":"rs-8153814","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}