非妊時の自己管理が良好ではなかった1型糖尿病をもつ女性の妊娠前から妊娠中期における経験と思い

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非妊時の自己管理が良好ではなかった1型糖尿病をもつ女性の妊娠前から妊娠中期にかけての糖尿病自己管理に関する経験と思いを明らかにし，求められる援助について考察することを目的として，3名の女性を研究参加者として半構成的面接調査を行った．得られたデータを修正版グラウンデッドアプローチを用いて質的帰納的に分析した結果（カテゴリーは【　】，概念は〈　〉で示す），1型糖尿病をもつ女性たちにとって糖尿病治療は，妊娠する前から生命維持のために必須であり，妊娠する前には，糖尿病の自己管理は〈適当に糖尿病自己管理をおこなっていた〉状態であった．血糖コントロールが悪い状態での妊娠のため，〈予期せぬ妊娠への戸惑い〉が生じ，指定された期限までに〈妊娠継続の決断〉を迫られ，糖尿病合併妊娠の管理を専門とする医師のいる病院へ移ることを余儀なくされる．妊娠による代謝の変化や妊娠維持と，より正常な児を得るために，今までとは異なる厳格な管理が必要となり，〈これまでの感覚に基づいた自己管理方法が通用しない〉と感じ，大きな戸惑いを抱く．妊娠中期には，インスリン抵抗性の増大に伴うインスリン投与量の増加，糖尿病合併症・産科的合併症の出現や悪化により〈妊娠経過への不安〉や〈子どもへの影響に関する不安〉を強く抱く．〈自己管理できないではすまされない〉と実感する．しかし，〈子どもが胎内に存在する感覚〉をもつとともに【糖尿病をもっているがゆえにハイリスク妊婦である】と認識し，〈元気な子どもをもつことへのこだわり〉を持つ．そして〈子どものために頑張らないといけない〉と強く思い，家族や同じ疾患を持つ仲間の存在に支えられ，前向きに治療に取り組んでいく．以上より，1型糖尿病をもつ女性への援助においては，妊娠前は計画妊娠への援助，妊娠初期は妊娠継続するか否かの自己決定を支える援助と妊娠中の自己管理の受け入れへの援助，妊娠中期は妊娠期特有の管理への戸惑いと無力感及び不安の表出への援助であると考えられた．In this study, we conducted research for the purpose of clarifying the experiences and emotion from the pre-pregnancy to puerperal period of women with type 1 diabetes mellitus in terms of self-controlling of diabetes, and considering what kind of care is necessary. This paper is to clarify the experiences and emotion of women with type 1 diabetes mellitus in pre-pregnancy to the second trimester. Semi-structured interviews were conducted with three women with type 1 diabetes mellitus. The data obtained from the interviews were transcribed and then were analyzed qualitatively and inductively based on the Modified Grounded Theory Approach. 【　】shows category and 〈　〉 shows concept. Medical treatment of diabetes prior to pregnancy was necessary for women with type 1 diabetes mellitus in order to maintain their lives. From the viewpoint of self-monitoring of diabetes, therefore, they were in the situation that they barely managed to lead a normal life under diabetic treatment before pregnancy. Since they became pregnant in a condition of poorly-controlled blood glucose, they were 〈puzzled by the unexpected pregnancy〉. Moreover, they were under pressure to 〈decide whether to maintain their pregnancy or not〉 by the designated deadline and forced to move to the hospital with doctors specializing in pregnancy with diabetic complications. So it was necessary for them to conduct severe self-control, which was different than before, party because their pregnancy caused metabolic alteration, and partly because they needed to maintain their pregnancy to have a normal child. As a result, they were completely confused, feeling that 〈the self-control method based on the sense they had prior to pregnancy was not sufficient any longer〉 and 〈I must do self-controlling of diabetes〉. In the second trimester, they were puzzled or strongly concerned about the effects of insulin resistance, diabetic or obestetric complications which enhanced 〈their concern about their pregnancy course〉 and 〈a sence of strong anxiety about the impact of their illness on their children〉. However, they had 〈a sense that they were having a child inside their wombs〉 and also recognized that 【high risk pregnant women due to diabetes】, so that they were determined to have a healthy child. Therefore, they strongly believed that 〈they would have to hang in for their child〉 and had a positive attitude towards their medical treatment, supported by their family or fellow patients with the same illness. What is important for us to think in supporting women with type 1 diabetes mellitus is to help them plan their pregnancy before they become pregnant, determine whether to keep their pregnancy or not and accept self-control conducted during pregnancy in early pregnancy, and express their worries and helpless feeling about pregnancy-related management in mid pregnancy.
2012-03-15

非妊時の自己管理が良好ではなかった1型糖尿病をもつ女性の妊娠前から妊娠中期における経験と思い

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