Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2022

Open Access 01-12-2022 | Gestational Diabetes | Research

A scoping review of gestational diabetes mellitus healthcare: experiences of care reported by pregnant women internationally

Authors: Sheila Pham, Kate Churruca, Louise A. Ellis, Jeffrey Braithwaite

Published in: BMC Pregnancy and Childbirth | Issue 1/2022

Login to get access

Abstract

Background

Gestational diabetes mellitus (GDM) is a condition associated with pregnancy that engenders additional healthcare demand. A growing body of research includes empirical studies focused on pregnant women’s GDM healthcare experiences. The aim of this scoping review is to map findings, highlight gaps and investigate the way research has been conducted into the healthcare experiences of women with GDM.

Methods

A systematic search of primary research using a number of databases was conducted in September 2021. Studies were included if they had an explicit aim of focusing on GDM and included direct reporting of participants’ experiences of healthcare. Key data from each study was extracted into a purposely-designed form and synthesised using descriptive statistics and thematic analysis.

Results

Fifty-seven articles were included in the analysis. The majority of studies used qualitative methodology, and did not have an explicit theoretical orientation. Most studies were conducted in urban areas of high-income countries and recruitment and research was almost fully conducted in clinical and other healthcare settings. Women found inadequate information a key challenge, and support from healthcare providers a critical factor. Experiences of prescribed diet, medication and monitoring greatly varied across settings. Additional costs associated with managing GDM was cited as a problem in some studies. Overall, women reported significant mental distress in relation to their experience of GDM.

Conclusions

This scoping review draws together reported healthcare experiences of pregnant women with GDM from around the world. Commonalities and differences in the global patient experience of GDM healthcare are identified.
Appendix
Available only for authorised users
Literature
1.
Dirar AM, Doupis J. Gestational diabetes from A to Z. World J Diabetes. 2017;8(12):489.CrossRef
2.
Metzger BE, Contreras M, Sacks D, et al. Hyperglycemia and adverse pregnancy outcomes. New Engl J Med. 2008;358(19):1991–2002.PubMedCrossRef
3.
Kim C. Gestational diabetes: risks, management, and treatment options. Int J Women’s Health. 2010;2:339.CrossRef
4.
5.
Xu T, Dainelli L, Yu K, et al. The short-term health and economic burden of gestational diabetes mellitus in China: a modelling study. BMJ Open. 2017;7(12):e018893.PubMedPubMedCentralCrossRef
6.
Behboudi-Gandevani S, Amiri M, Bidhendi Yarandi R, Ramezani Tehrani F. The impact of diagnostic criteria for gestational diabetes on its prevalence: a systematic review and meta-analysis. Diabetol Metab Syndr. 2019;11(1):11.PubMedPubMedCentralCrossRef
7.
Lawrence RL, Wall CR, Bloomfield FH. Prevalence of gestational diabetes according to commonly used data sources: an observational study. BMC Pregnancy and Childbirth. 2019;19(1):349.PubMedPubMedCentralCrossRef
8.
9.
Pu J, Zhao B, Wang EJ, et al. Racial/ethnic differences in gestational diabetes prevalence and contribution of common risk factors. Paediatr Perinat Epidemiol. 2015;29(5):436–43.PubMedPubMedCentralCrossRef
10.
Lavender T, Platt MJ, Tsekiri E, et al. Women’s perceptions of being pregnant and having pregestational diabetes. Midwifery. 2010;26(6):589–95.PubMedCrossRef
11.
Nielsen KK, Kapur A, Damm P, de Courten M, Bygbjerg IC. From screening to postpartum follow-up - the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review. BMC Pregnancy and Childbirth. 2014;14:41.PubMedPubMedCentralCrossRef
12.
Nielsen KK, Damm P, Bygbjerg IC, Kapur A. Barriers and facilitators for implementing programmes and services to address hyperglycaemia in pregnancy in low and middle income countries: a systematic review. Diabetes Res Clin Pract. 2018;145:102–18.CrossRef
13.
Costi L, Lockwood C, Munn Z, Jordan Z. Women’s experience of diabetes and diabetes management in pregnancy: a systematic review of qualitative literature. JBI Database Syst Rev Implement Rep. 2014;12(1):176–280.CrossRef
14.
Parsons J, Ismail K, Amiel S, Forbes A. Perceptions among women with gestational diabetes. Qual Health Res. 2014;24(4):575–85.PubMedCrossRef
15.
Van Ryswyk E, Middleton P, Shute E, Hague W, Crowther C. Women’s views and knowledge regarding healthcare seeking for gestational diabetes in the postpartum period: a systematic review of qualitative/survey studies. Diabetes Res Clin Pract. 2015;110(2):109–22.PubMedCrossRef
16.
He J, Chen X, Wang Y, Liu Y, Bai J. The experiences of pregnant women with gestational diabetes mellitus: a systematic review of qualitative evidence. Rev Endocr Metab Disord. 2021;22(4):777–87. Epub 2020 Nov 12.PubMedCrossRef
17.
Craig L, Sims R, Glasziou P, Thomas R. Women’s experiences of a diagnosis of gestational diabetes mellitus: a systematic review. BMC Pregnancy and Childbirth. 2020;20(1):76.PubMedPubMedCentralCrossRef
18.
Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):143.PubMedPubMedCentralCrossRef
19.
Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73.PubMedCrossRef
20.
21.
Lawson EJ, Rajaram S. A transformed pregnancy: the psychosocial consequences of gestational diabetes. Sociol Health Illn. 1994;16(4):536–62.CrossRef
22.
Ge L, Wikby K, Rask M. Lived experience of women with gestational diabetes mellitus living in China: a qualitative interview study. BMJ Open. 2017;7(11):e017648.PubMedPubMedCentralCrossRef
23.
Morrison MK, Lowe JM, Collins CE. Australian women’s experiences of living with gestational diabetes. Women Birth. 2014;27(1):52–7.PubMedCrossRef
24.
Gray MF, Hsu C, Kiel L, Dublin S. “It’s a very big burden on me”: women’s experiences using insulin for gestational diabetes. Matern Child Health J. 2017;21(8):1678–85.CrossRef
25.
Whitty-Rogers J, Caine V, Cameron B. Aboriginal women’s experiences with gestational diabetes mellitus: a participatory study with Mi’kmaq women in Canada. Adv Nurs Sci. 2016;39(2):181–98.CrossRef
26.
Kirkham R, King S, Graham S, Boyle JA, Whitbread C, Skinner T, et al. “No sugar”, “no junk food”, “do more exercise” - moving beyond simple messages to improve the health of Aboriginal women with Hyperglycaemia in Pregnancy in the Northern Territory - A phenomenological study. Women Birth. 2021;34(6):578–84. https://​doi.​org/​10.​1016/​j.​wombi.​2020.​10.​003. Epub 2020 Nov 2.CrossRefPubMed
27.
Collier SA, Mulholland C, Williams J, Mersereau P, Turay K, Prue C. A qualitative study of perceived barriers to management of diabetes among women with a history of diabetes during pregnancy. J Women’s Health. 2011;20(9):1333–9.CrossRef
28.
29.
Trutnovsky G, Panzitt T, Magnet E, Stern C, Lang U, Dorfer M. Gestational diabetes: women’s concerns, mood state, quality of life and treatment satisfaction. J Matern-Fetal Neonatal Med. 2012;25(11):2464–6.PubMedCrossRef
30.
Nicolosi BF, Lima SAM, Rodrigues MRK, et al. Prenatal care satisfaction: perception of caregivers with diabetes mellitus. Rev Bras Enferm. 2019;72(suppl 3):305–11.PubMedCrossRef
31.
Dayyani I, Maindal HT, Rowlands G, Lou S. A qualitative study about the experiences of ethnic minority pregnant women with gestational diabetes. Scand J Caring Sci. 2019;33(3):621–31.PubMedCrossRef
32.
Mensah GP, van Rooyen DRM, ten Ham-Baloyi W. Nursing management of gestational diabetes mellitus in Ghana: perspectives of nurse-midwives and women. Midwifery. 2019;71:19–26.PubMedCrossRef
33.
Kragelund Nielsen K, Vildekilde T, Kapur A, Damm P, Seshiah V, Bygbjerg IC. “If I Don’t Eat Enough, I Won't Be Healthy”. Women’s Experiences with Gestational Diabetes Mellitus Treatment in Rural and Urban South India. Int J Environ Res Public Health. 2020;17(9):3062.
34.
Mufdlilah M, Efriani R, Rokhanawati D, Dzakiyullah NR. Mother’s obstacles in managing gestational diabetes mellitus: A Qualitative study. Ann Trop Med Public Health. 2020;23(S9):SP23942.
35.
Khooshehchin TE, Keshavarz Z, Afrakhteh M, Shakibazadeh E, Faghihzadeh S. Perceived needs in women with gestational diabetes: a qualitative study. Electron physician. 2016;8(12):3412–20.PubMedPubMedCentralCrossRef
36.
Kolivand M, Keramat A, Rahimi M, Motaghi Z, Shariati M, Emamian M. Self-care education needs in gestational diabetes tailored to the Iranian culture: a qualitative content analysiss. Iran J Nurs Midwifery Res. 2018;23(3):222–9.PubMedPubMedCentralCrossRef
37.
Hussain Z, Yusoff ZM, Sulaiman SA. A study exploring the association of attitude and treatment satisfaction with glycaemic level among gestational diabetes mellitus patients. Prim Care Diabetes. 2015;9(4):275–82.PubMedCrossRef
38.
39.
Reid J, Anderson A, Cormack D, et al. The experience of gestational diabetes for indigenous Māori women living in rural New Zealand: qualitative research informing the development of decolonising interventions. BMC Pregnancy Childbirth. 2018;18:478.PubMedPubMedCentralCrossRef
40.
Helmersen M, Sorensen M, Lukasse M, Laine HK, Garnweidner-Holme L. Women’s experience with receiving advice on diet and self-monitoring of blood glucose for gestational diabetes mellitus: a qualitative study. Scand J Prim Health Care. 2021;39(1):44–50.PubMedPubMedCentralCrossRef
41.
Hewage S, Audimulam J, Sullivan E, Chi C, Yew TW, Yoong J. Barriers to Gestational Diabetes Management and Preferred Interventions for Women With Gestational Diabetes in Singapore: Mixed Methods Study. JMIR Form Res. 2020;4(6):e14486.
42.
Dickson LM, Buchmann EJ, Norris SA. Women’s accounts of the gestational diabetes experience – a South African perspective. S Afr J Obstet Gynaecol. 2020;26(1):1–7.
43.
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 Women’s Health. 2020;20(1):231.PubMedPubMedCentralCrossRef
44.
Hirst JE, Tran TS, My ATD, Rowena F, Morris JM, Jeffery HE. Women with gestational diabetes in Vietnam: a qualitative study to determine attitudes and health behaviours. BMC Pregnancy and Childbirth. 2012;12:10.CrossRef
45.
Mukona D, Munjanja SP, Zvinavashe M, Stray-Pederson B. Barriers of adherence and possible solutions to nonadherence to antidiabetic therapy in women with diabetes in pregnancy: Patients’ perspective. J Diabetes Res. 2017;2017:3578075.
46.
Rasekaba T, Nightingale H, Furler J, Lim WK, Triay J, Blackberry I. Women, clinician and IT staff perspectives on telehealth for enhanced gestational diabetes mellitus management in an Australian rural/regional setting. Rural Remote Health. 2021;21(1):5983.PubMed
47.
Tait Neufeld H. Patient and caregiver perspectives of health provision practices for First Nations and Métis women with gestational diabetes mellitus accessing care in Winnipeg, Manitoba. BMC Health Serv Res. 2014;14:440.
48.
Pace R, Loon O, Chan D, Porada H, Godin C, Linton J, et al. Preventing diabetes after pregnancy with gestational diabetes in a Cree community: an inductive thematic analysis. BMJ Open Diabetes Res Care. 2020;8(1):e001286.
49.
Oster RT, Mayan MJ, Toth EL. Diabetes in pregnancy among First Nations women. Qual Health Res. 2014;24(11):1469–80.PubMedCrossRef
50.
Ge L, Wikby K, Rask M. ’Is gestational diabetes a severe illness?‘ exploring beliefs and self-care behaviour among women with gestational diabetes living in a rural area of the south east of China. Aust J Rural Health. 2016;24(6):378–84.PubMedCrossRef
51.
Abraham K, Wilk N. Living with gestational diabetes in a rural community. MCN Am J Mater Child Nurs. 2014;39(4):239–45.CrossRef
52.
Anderberg E, Berntorp K, Crang-Svalenius E. Diabetes and pregnancy: women’s opinions about the care provided during the childbearing year. Scand J Caring Sci. 2009;23(1):161–70.PubMedCrossRef
53.
McCloskey L, Sherman ML, St John M, et al. Navigating a ‘perfect storm’ on the path to prevention of type 2 diabetes mellitus after gestational diabetes: lessons from patient and provider narratives. Matern Child Health J. 2019;23(5):603–12.PubMedCrossRef
54.
Bandyopadhyay M. Gestational diabetes mellitus: a qualitative study of lived experiences of South Asian immigrant women and perspectives of their health care providers in Melbourne, Australia. BMC Pregnancy and Childbirth. 2021;21(1):500.PubMedPubMedCentralCrossRef
55.
Nolan JA, McCrone S, Chertok IRA. The maternal experience of having diabetes in pregnancy. J Am Acad Nurs Pract. 2011;23(11):611–8.CrossRef
56.
Jarvie R. Lived experiences of women with co-existing BMI ≥ 30 and gestational diabetes mellitus. Midwifery. 2017;49:79–86.PubMedCrossRef
57.
Hjelm K, Berntorp K, Apelqvist J. Beliefs about health and illness in Swedish and African-born women with gestational diabetes living in Sweden. J Clin Nurs. 2012;21(9–10):1374–86.PubMedCrossRef
58.
Razee H, van der Ploeg HP, Blignault I, et al. Beliefs, barriers, social support, and environmental influences related to diabetes risk behaviours among women with a history of gestational diabetes. Health Promot J Aust. 2010;21(2):130–7.CrossRef
59.
Hjelm K, Bard K, Apelqvist J. Gestational diabetes: prospective interview-study of the developing beliefs about health, illness and health care in migrant women. J Clin Nurs. 2012;21(21–22):3244–56.PubMedCrossRef
60.
Hjelm K, Bard K, Apelqvist J. A qualitative study of developing beliefs about health, illness and healthcare in migrant African women with gestational diabetes living in Sweden. BMC Women’s Health. 2018;18(1):34.PubMedPubMedCentralCrossRef
61.
Persson M, Winkvist A, Mogren I. ’From stun to gradual balance’- women’s experiences of living with gestational diabetes mellitus. Scand J Caring Sci. 2010;24(3):454–62.PubMedCrossRef
62.
Bandyopadhyay M, Small R, Davey MA, Oats JJN, Forster DA, Aylward A. Lived experience of gestational diabetes mellitus among immigrant South Asian women in Australia. Aust New Z J Obstet Gynaecol. 2011;51(4):360–4.CrossRef
63.
Carolan M, Gill GK, Steele C. Women’s experiences of factors that facilitate or inhibit gestational diabetes self-management. BMC Pregnancy and Childbirth. 2012;12:99.PubMedPubMedCentralCrossRef
64.
Carolan M. Women’s experiences of gestational diabetes self-management: a qualitative study. Midwifery. 2013;29(6):637–45.PubMedCrossRef
65.
Parsons J, Sparrow K, Ismail K, Hunt K, Rogers H, Forbes A. Experiences of gestational diabetes and gestational diabetes care: a focus group and interview study. BMC Pregnancy Childbirth. 2018;18(1):25.PubMedPubMedCentralCrossRef
66.
Sayakhot P, Carolan-Olah M. Sources of information on Gestational Diabetes Mellitus, satisfaction with diagnostic process and information provision. BMC Pregnancy Childbirth. 2016;16(1):287.PubMedPubMedCentralCrossRef
67.
Evans MK, O’Brien B. Gestational diabetes: the meaning of an at-risk pregnancy. Qual Health Res. 2005;15(1):66–81.PubMedCrossRef
68.
Carolan-Olah M, Gill G, Steel C. Women’s experiences of gestational diabetes self-management: A qualitative study. Women and Birth. 2013;26(1):S2-S.CrossRef
69.
Wah YYE, McGill M, Wong J, Ross GP, Harding AJ, Krass I. Self-management of gestational diabetes among Chinese migrants: A qualitative study. Women and Birth. 2019;32(1):E17–23.PubMedCrossRef
70.
Jirojwong S, Brownhill S, Dahlen HG, Johnson M, Schmied V. Going up, going down: the experience, control and management of gestational diabetes mellitus among Southeast Asian migrant women living in urban Australia. Health Promot J Aust. 2017;28(2):123–31.CrossRef
71.
Carolan-Olah M, Duarte-Gardea M, Lechuga J, Salinas-Lopez S. The experience of gestational diabetes mellitus (GDM) among Hispanic women in a U.S. border region. Sex Reprod HealthC. 2017;12:16–23.PubMedCrossRef
72.
Hjelm K, Bard K, Nyberg P, Apelqvist J. Swedish and Middle-Eastern-born women’s beliefs about gestational diabetes. Midwifery. 2005;21(1):44–60.PubMedCrossRef
73.
Hjelm K, Bard K, Nyberg P, Apelqvist J. Management of gestational diabetes from the patient’s perspective–a comparison of Swedish and Middle-Eastern born women. J Clin Nurs. 2007;16(1):168–78.PubMedCrossRef
74.
Hjelm K, Bard K, Apelqvist J. Gestational diabetes: prospective interview-study of the developing beliefs about health, illness and health care in migrant women. J Clin Nurs. 2012;21(21–22):3244–56.PubMedCrossRef
75.
Dayyani I, Terkildsen Maindal H, Rowlands G, Lou S. A qualitative study about the experiences of ethnic minority pregnant women with gestational diabetes. Scand J Caring Sci. 2019;33(3):621–31.PubMedCrossRef
76.
Ge L, Wikby K, Rask M. Quality of care from the perspective of women with gestational diabetes in China. Int J Gynecol Obstet. 2016;134(2):151–5.CrossRef
77.
Hui AL, Sevenhuysen G, Harvey D, Salamon E. Food choice decision-making by women with gestational diabetes. Can J Diabetes. 2014;38(1):26–31.PubMedCrossRef
78.
Draffin CR, Alderdice FA, McCance DR, et al. Exploring the needs, concerns and knowledge of women diagnosed with gestational diabetes: A qualitative study. Midwifery. 2016;40:141–7.PubMedCrossRef
79.
Boyd J, McMillan B, Easton K, Delaney B, Mitchell C. Utility of the COM-B model in identifying facilitators and barriers to maintaining a healthy postnatal lifestyle following a diagnosis of gestational diabetes: a qualitative study. BMJ Open. 2020;10(8):e037318.PubMedPubMedCentralCrossRef
80.
Hjelm K, Berntorp K, Frid A, Aberg A, Apelqvist J. Beliefs about health and illness in women managed for gestational diabetes in two organisations. Midwifery. 2008;24(2):168–82.PubMedCrossRef
81.
Hjelm K, Bard K, Nyberg P, Apelqvist J. Management of gestational diabetes from the patient’s perspective - a comparison of Swedish and Middle-Eastern born women. J Clin Nurs. 2007;16(1):168–78.PubMedCrossRef
82.
Nur Suraiya AHS, Zahara AM, Nazlena MA, Suzana S, Norazlin MI, Sameeha MJ. Perspectives of healthcare professionals and patients on management of gestational diabetes mellitus: a qualitative study in Negeri Sembilan, Malaysia. Malays J Nutr. 2016;21(3):393–9.
83.
Siad FM, Fang XY, Santana MJ, Butalia S, Hebert MA, Rabi DM. Understanding the experiences of East African immigrant women with gestational diabetes mellitus. Can J Diabetes. 2018;42(6):632–8.PubMedCrossRef
84.
Kaptein S, Evans M, McTavish S, et al. The subjective impact of a diagnosis of gestational diabetes among ethnically diverse pregnant women: a qualitative study. Can J Diabetes. 2015;39(2):117–22.PubMedCrossRef
85.
Hammarberg K, Kirkman M, de Lacey S. Qualitative research methods: when to use them and how to judge them. Hum Reprod. 2016;31(3):498–501.PubMedCrossRef
86.
Alspaugh A, Barroso J, Reibel M, Phillips S. Women’s contraceptive perceptions, beliefs, and attitudes: an integrative review of qualitative research. J Midwifery & Women’s Health. 2020;65(1):64–84.CrossRef
87.
Råheim M, Magnussen LH, Sekse RJ, Lunde Å, Jacobsen T, Blystad A. Researcher-researched relationship in qualitative research: Shifts in positions and researcher vulnerability. Int J Qual Stud Health Well-being. 2016;11:30996.PubMedCrossRef
88.
Rees SE, Chadha R, Donovan LE, et al. Engaging patients and clinicians in establishing research priorities for gestational diabetes mellitus. Can J Diabetes. 2017;41(2):156–63.PubMedCrossRef
89.
Ge L, Albin B, Hadziabdic E, Hjelm K, Rask M. Beliefs about health and illness and health-related behavior among urban women with gestational diabetes mellitus in the south east of China. J Transcult Nurs. 2016;27(6):593–602.PubMedCrossRef
90.
91.
Kuhlmann E, Annandale E. Gender and Healthcare Policy. In: Kuhlmann E, Blank RH, Bourgeault IL, Wendt C, editors. The Palgrave International Handbook of Healthcare Policy and Governance. London: Palgrave Macmillan UK; 2015. p. 578–96.CrossRef
92.
Nielsen KK, de Courten M, Kapur A. Health system and societal barriers for gestational diabetes mellitus (GDM) services - lessons from World Diabetes Foundation supported GDM projects. BMC Int Health Hum Rights. 2012;12:33.PubMedPubMedCentralCrossRef
93.
Goldenberg RL, McClure EM, Harrison MS, Miodovnik M. Diabetes during Pregnancy in Low- and Middle-Income Countries. Am J Perinatol. 2016;33(13):1227–35.PubMedCrossRef
94.
Liu B. Sentiment analysis and opinion mining. Synthesis Lectures on Human Language Technologies. 2012;5(1):1–167.CrossRef
Metadata
Title
A scoping review of gestational diabetes mellitus healthcare: experiences of care reported by pregnant women internationally
Authors
Sheila Pham
Kate Churruca
Louise A. Ellis
Jeffrey Braithwaite
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2022
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-022-04931-5

Other articles of this Issue 1/2022

BMC Pregnancy and Childbirth 1/2022 Go to the issue

Case report

Neonatal eyelid penetration from insertion of a fetal scalp electrode: a case report

Research

Healthcare professionals’ experiences and perceptions regarding health care of indigenous pregnant women in Ecuador

Research

Gestational age-based reference ranges for cervical length and preterm birth prediction in triplet pregnancies: an observational retrospective study

Research

The Maternal Postpartum Quality of Life Instrument (MPQOL-I): development and psychometric evaluation in an exploratory sequential mixed-method study

Research

Facilitators and barriers influencing weight management behaviours during pregnancy: a meta-synthesis of qualitative research

Research

Screening high-risk population of persistent postpartum hypertension in women with preeclampsia using latent class cluster analysis