An Adapted Focused Antenatal Care Programme for pregnant women diagnosed with diabetes to prevent neonatal complications in Limpopo Province, South Africa

Abstract

Background: The impact of pregnancy diabetes mellitus, pre- and gestational forms a serious public health issue, particularly in countries with a resource-challenged environment such as South Africa. Maternal hyperglycemia is associated with adverse aftermath, including fetal macrosomia, neonatal hypoglycemia, stillbirth, and a higher perinatal mortality. Traditional antenatal care often fails to provide adequate care for the health needs of pregnant women with diabetes, losing out on early detection and management. Thus, an adopted Focused Antenatal Care (aFANC) program specific to these requirements is necessary to improve maternal and neonatal health. Purpose: The main aim of the study was to develop an adopted Focused Antenatal Care (FANC) model or programme for this population: the aFANC programme, designed to prevent neonatal complications related to diabetic pregnancies in Limpopo Province, South Africa. Methods: The research adopted a convergent parallel mixed-methods design using primary healthcare facilities and hospitals in selected districts of Limpopo Province. Participants included pregnant women with a diabetes diagnosis, midwives, and pertinent clinical documents. Quantitative data were gathered using structured questionnaires and retrospective reviews of maternity case records, while qualitative data were collected through individual in-depth interviews. Quantitative data were analyzed using SPSS version 26, and qualitative data were analyzed thematically. Applied programme development was guided by the Intervention Mapping framework, with the results of both strands reported. Ethical principles and measures to ensure trustworthiness were adhered to in both strands. Results: From a patient perspective, pregnant women had knowledge of diabetes in pregnancy but were not familiar with major risk factors for diabetes or crucial diagnostic tests, such as the oral glucose tolerance test (OGTT). Systemic obstacles, including long wait times for services, scarce medical resources, and negative attitudes among health workers, and patient-centered barriers such as transportation and long distances to clinics, also hindered care. From the healthcare provider and system perspective, midwives had good theoretical knowledge of managing diabetes in pregnancy but poor practical skills, mainly due to a lack of specific training and limited opportunities for continuous professional development. Poor documentation and inconsistent compliance with guidelines from clinical records were revealed through audits. Moreover, systemic barriers, including staff shortages, heavy workloads, lack of multidisciplinary collaboration, and insufficient supervision, limited service delivery. Conclusion: The successful management of diabetes in pregnancy in Limpopo Province is hindered by interrelated patient-provider-system-level obstacles. This information underpinned the development of a tailored, adopted FANC programme that aims to increase provider competencies, improve patient education and engagement, and address systemic vulnerabilities to improve maternal and infant health.