Background:
The prevalence of diabetes (DM) during pregnancy has increased. Effective management of diabetes during pregnancy is a public health priority because diabetes might adversely affect the health of a woman and her child.

Objectives:
This study explores knowledge, attitudes, experiences, and practices of health care providers (HCPs) and women about pregnancy and diabetes.

Methods:
Focus groups were conducted in Atlanta, GA with HCPs (six groups); women with gestational diabetes [GDM] (nine groups); and women with pre-existing diabetes before pregnancy [PEDM](seven groups). Women were eligible if they were black, white, or Hispanic; pregnant or had a live birth within four years; and had diabetes during pregnancy. Atlas.ti® was used for qualitative analysis.

Results:
Fifty-three HCPs and 89 women participated (49 with GDM, 40 with PEDM). HCPs concerns focused on disease management, but felt that the greatest barriers for women were lack of knowledge and awareness, lack of access, and attitudinal barriers. Most HCPs reported low rates of pregnancy planning among their patients with diabetes in pregnancy. HCPs used a variety of guidelines for managing diabetes in pregnancy.
Women in both groups focused on concerns for their babies. Barriers were similar across groups with financial, lifestyle, and communication/informational barriers most common. Planning pregnancy was not a strategy to ensure positive pregnancy outcomes. Women were confused by varying blood glucose values and guidelines used by providers. Women were not very knowledgeable about the consequences of diabetes on their or their baby's health. Conversion to type 2 diabetes was not mentioned as a concern in either HCP or GDM groups.


Conclusion and implications for practice:
Barriers to effective management of diabetes during pregnancy include systemic issues such as financial costs and access to care as well as individual issues such as high rates of unplanned pregnancies, lack of knowledge/information, and difficulty making healthy lifestyle choices. Addressing barriers to care and disseminating consistent messages to women with or at risk for diabetes and capable of becoming pregnant are needed to help prevent adverse pregnancy outcomes associated with poor glycemic control. Long-term follow-up for women with GDM might reduce conversion to type 2 diabetes, potentially reducing the number of pregnancies exposed to pre-existing diabetes.