Vivências de gestantes com doença crônica e suas estratégias de enfrentamento

Abstract

Pregnancy can be considered as a unique event in a woman's life and can be understood as part of the human development process. However, it can represent new challenges for pregnant women, in addition to arousing varied feelings, as in pregnant women with chronic disease, which are classified as high-risk pregnancy due to greater chances of developing complications that harm the life of the woman and her baby. This experience can generate constant concerns about possible gestational complications due to chronic disease, being understood as a stress-generating factor. Considering the scarcity of studies on pregnancy beyond the biological discourse, and gaps in the scientific literature for understanding pregnant women with a chronic health condition and their ways of coping, the general objective of the dissertation, divided into two studies, was to understand the experiences of high-risk pregnant women, due to the existence of a chronic disease prior to pregnancy, and their coping strategies. The purpose of Study 1 was to identify and describe how women living with chronic disease experience pregnancy. Study 2 aimed to understand the coping strategies used by these pregnant women. Both studies were conducted using the qualitative approach. The research population consisted of 8 pregnant women, over 18 years of age, living in the interior of Minas Gerais, with chronic disease prior to pregnancy, followed up in an outpatient clinic specialized in the care of high-risk pregnant women, at a university hospital located in the aforementioned brazilian region. The recruitment started with the active search of the participants in the waiting room of the referred outpatient clinic, identifying patients with previous chronic disease, through an informal dialogue with the pregnant women, and subsequent presentation of the research objectives to them. Upon acceptance to participate in the study, 2 individual interviews were scheduled, initially carried out at the participants' homes. However, due to the context of the pandemic by COVID-19, the other 6 interviews were conducted by phone call, due to the greater availability of pregnant women to this means of communication. A field diary was also produced after each interview. Data analysis was carried out from the full transcript of the interviews, which were read in a curious and exhaustive manner, emerging from them various themes in which we sought to reflect and respond to the objectives of the study. The thematic axes were analyzed, in Study1, anchored in the available literature on pregnant women, chronic diseases and on the perspective of social constructionism, and in Study 2, in the theory of coping and in studies on pregnant women and chronic diseases. The participants' reports demonstrate that the news of a pregnancy had significant impacts on their lives, translated into fears and concerns. The fact that there is a chronic illness prior to pregnancy may have intensified the negative feelings and insecurities. They also demonstrated that living with pregnancy and chronic illness widened their views to the differences of the current pregnancy with previous pregnancies, in addition to changes in emotional aspects and self-care with the chronic illness. Negative emotional repercussions from the discovery of chronic disease and worsening of the disease during pregnancy have been reported. The main coping strategies used were related to self-care, social and family support and support in religiosity / spirituality. The highlighted challenges were food, treatment and transportation to prenatal care. The importance of adequately welcoming this population is verified, minimizing possible damage to their mental health.