Exploring the acceptability of a risk prediction tool for cardiometabolic risk (gestational diabetes and hypertensive disorders of pregnancy) for use in early pregnancy: A qualitative study

Sarah Lang; Jennifer G McIntosh; Joanne Enticott; Rebecca Goldstein; Susanne Baker; Margaret McGowan; Shamil Cooray; Lan Du; Anjana Reddy; Cheryce L Harrison; Eleanor Thong; Kushan De Silva; Helena Teede; Lisa J Moran; Siew Lim

doi:10.1016/j.midw.2024.104270

Exploring the acceptability of a risk prediction tool for cardiometabolic risk (gestational diabetes and hypertensive disorders of pregnancy) for use in early pregnancy: A qualitative study

Midwifery. 2024 Dec 19:141:104270. doi: 10.1016/j.midw.2024.104270. Online ahead of print.

Authors

Affiliations

¹ Monash Centre for Health Research and Implementation, School of Clinical Sciences, Monash University, Victoria, Australia.
² Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; Department of General Practice and Primary Care, University of Melbourne, Melbourne, Victoria, Australia.
³ Monash Centre for Health Research and Implementation, School of Clinical Sciences, Monash University, Victoria, Australia; Department of General Practice and Primary Care, University of Melbourne, Melbourne, Victoria, Australia.
⁴ Department of Data Science and AI, Faculty of Information Technology, Monash University, Victoria, Australia.
⁵ Endocrine and Diabetes Units, Monash Health, Victoria, Australia.
⁶ Department of Diagnostics and Intervention, Umeå University, Umeå, Sweden.
⁷ Health Systems and Equity, Eastern Health Clinical School, Monash University, Australia. Electronic address: siew.lim1@monash.edu.

PMID: 39755013
DOI: 10.1016/j.midw.2024.104270

Abstract

Problem/ background: The acceptability of providing women with personalised cardiometabolic risk information using risk prediction tools early in pregnancy is not well understood.

Aim: To explore women's and healthcare professionals' perspectives of the acceptability of a prognostic, composite risk prediction tool for cardiometabolic risk (gestational diabetes and/or hypertensive disorders of pregnancy) for use in early pregnancy.

Methods: Semi-structured interviews were conducted to explore the acceptability of cardiometabolic risk prediction tools, preferences for risk communication and considerations for implementation into antenatal care. The Theoretical Framework of Acceptability informed interview questions. Transcripts were thematically analysed.

Findings: Women ≤24 weeks' gestation (n = 13) and healthcare professionals (n = 8), including midwives (n = 2), general practitioners (n = 2), obstetricians (n = 2), an endocrinologist (n = 1) and cardiologist (n = 1) participated. Participants indicated that providing personalised risk information is only appropriate when preventative measures can be initiated to mitigate risks. Differentiating the risk for each condition (single risk outputs) was often preferred to composite risk outputs to enable targeted monitoring and management. Defining conditions and risks to mother/baby, visually depicting personalised risk scores, and providing clear, patient-centred clinical management plans were recommended. Supportive clinical policy changes, staff engagement/training, and integration into electronic health records were suggested to facilitate uptake into routine antenatal care.

Conclusion: Women and healthcare professionals suggested that early pregnancy cardiometabolic risk prediction tools may be acceptable when preventative interventions are available to reduce risks. Risk prediction tools with integrated patient-centred education materials may promote timely access and engagement with preventative interventions to optimise women's current and future health.

Keywords: Diabetes; Gestational; Hypertension; Pregnancy Outcomes; Pregnancy-Induced; Prenatal Care; Risk Communication.