The diagnosis of hyperglycemia during pregnancy can affect many aspects of a woman’s life. The QoL of these women may be adversely affected by the resulting changes in mood and perceived health, and a partial loss of control over one’s own body [11, 14, 21].
Due to the continuously growing interest in patients’ QoL during illness and treatment, numerous studies have been published on the adverse impact of such conditions as type 1 or type 2 diabetes on QoL in adults and children [22–25]. However, research on the impact of hyperglycemia on the QoL of women during pregnancy is still lacking [11, 14, 26–28]. To the best of our knowledge, the present study is one of few addressing the association between illness acceptance and QoL in pregnant women with hyperglycemia.
Our findings demonstrate poorer overall QoL and perceived health in pregnant women with hyperglycemia compared to healthy pregnant women. This is consistent with other published reports [4, 14, 26]. A similar difference between healthy and diabetic women was reported in studies on women who were not pregnant . In the literature, somewhat different reports can also be found, where general perceived health was lower in ill individuals than in healthy ones (similarly to our study), but overall QoL was rated higher by hyperglycemic respondents than by healthy controls .
In our study, pregnant women with hyperglycemia rated their overall QoL higher than their overall perceived health. Similar findings have been reported in other studies on the QoL of pregnant women  and non-pregnant diabetic women aged 45–55 . GDM diagnosis also adversely affected perceived QoL in pregnant women in a tertiary health care center in India  and pregnant women in the US state of West Virginia .
The highest scores for specific QoL domains among hyperglycemic pregnant women in our study were found in the “social relationships” domain, which is consistent with other studies on the QoL of pregnant women and of patients with type 1 and 2 diabetes [11, 26].
In our study, the lowest-scored domain was physical QoL, as in a Brazilian study on pregnant women with diabetes or mild hyperglycemia . Other researchers studying pregnant women with hyperglycemia reported the lowest scores for the psychological domain [11, 26]. Thus, research shows women with diabetes during or beyond pregnancy as individuals experiencing limitations in the performance of their social roles, resulting from their illness interfering with multiple aspects of functioning, both physical and psychological.
QoL may be affected by a multitude of factors. In addition to the clinical symptoms and the treatment used, a significant impact was found for such socio-demographic characteristics as residence, education, relationship status, and professional activity, among other factors [11, 14, 29].
In our study, pregnant women with hyperglycemia who were married reported better QoL in the psychological and environmental domains than unmarried respondents. One may hypothesize that this was due to a greater sense of security experienced by women in a legally sanctioned relationship. Similar conclusions were also reported by researchers from Columbia, who studied healthy pregnant women .
Residence also affected reported QoL. The best overall QoL, perceived health, and QoL in the environmental domain was reported by rural residents, and the poorest by women living in smaller towns. Conversely, in a study of patients with Parkinson’s disease, urban residents reported the best QoL .
QoL in our study also depended on education. The highest overall QoL scores were found among women with a primary education, and the lowest among high school graduates. But QoL in the physical, psychological, and environmental domains was highest for women with a college/university education.
Similarly, in a study on women with type 2 diabetes in Iran , the best QoL in specific WHOQOL-BREF domains was reported by women who had completed higher education. Better QoL was also associated with better education in diabetic patients from Spain  and South Asia . It seems that better education entails more confidence, security, and a better relationship with others.
In our study, professionally active women reported better QoL in the environmental domain. The positive correlation between professional activity and QoL was also reported in other studies on patients with type 2 diabetes [30, 12] or Parkinson’s disease . Chronically ill patients, including pregnant women with hyperglycemia, who remain professionally active seem to have better access to information and medical care, as well as a greater sense of physical and psychological security than those who do not work.
Pregnant women reporting very good living conditions had the highest scores for overall QoL, general health and QoL in all specific WHOQOL-BREF domains. In a similar study on pregnant women with hyperglycemia, the same relationship was demonstrated for the physical, psychological and environmental QoL domains . Better socio-economic status was also associated with better QoL assessed using the SF-36 questionnaire in women with GDM  and in healthy pregnant women . Based on these findings, better living conditions seem to foster a sense of security and a better perception of oneself and one’s environment.
In our study, the best QoL in the psychological and social domains was found for women pregnant for the first time, while in a study from central Anatolia, Turkey, the highest scores were reported for women in the third trimester of the pregnancy . Additional housework and tasks related to raising children, reducing the time that the woman has for herself, may be factors that impair the QoL of women going through a subsequent pregnancy .
In the present study, the poorest overall QoL, perceived health, and QoL in specific WHOQOL-BREF domains was found in women with the least self-reported knowledge on lifestyle and treatment in diabetes and on the associated potential for pregnancy complications and baby health impact. In a study performed in another region of Poland, less knowledge on diabetes in women with GDM was likewise associated with poorer QoL . According to the available reports, diabetes education provided to type 2 diabetes patients improved their QoL (9,24). However, in another study on women with hyperglycemia during pregnancy , a correlation with knowledge was only found for perceived general health. Pregnant women reporting a moderate level of knowledge on diabetes in pregnancy obtained the highest scores in this WHOQOL-BREF domain . The cited findings suggest a positive impact of diabetes education on multiple aspects of hyperglycemic patients’ lives.
In our study, the poorest perceived health and QoL in the physical and psychological domains was reported by women diagnosed with glucose metabolism disorders after week 28 of the pregnancy, i.e. ones with the shortest duration of illness. Contrasting findings were reported in other studies, where QoL decreased as illness duration increased [30, 31].
Initiation of insulin therapy for diabetic patients is considered one of the three crises in the treatment process, alongside diabetes diagnosis itself and the diagnosis of complications . Treatment type was also similarly correlated with QoL in our group. In Poland, carbohydrate metabolism disorders during pregnancy are treated with diet and insulin: oral hypoglycemic agents are not prescribed. Highest scores for overall QoL and psychological QoL were obtained by women treated with diet and exercise, and the lowest by those on insulin therapy. These findings are corroborated by most studies on the QoL of women with hyperglycemia in pregnancy [11, 13, 14, 27] and on QoL of non-pregnant diabetic patients [12, 30, 34]. Similar results were reported in studies on type 2 diabetes patients  and on pregnant women in Austria , though in these cases, poorer QoL was only found at the beginning of insulin therapy. The authors emphasize that the increase in reported QoL in the subsequent months of insulin therapy is associated with education provided to the patients, which reduces their fear of injections and concerns about the insulin administration technique. However, another study  reported no negative impact of insulin treatment on patients’ QoL.
The mean illness acceptance score in our group was 31.37 points, which was near the lower boundary of “moderate”. A comparison with reports by other authors demonstrates that the mean acceptance level was higher in hyperglycemic pregnant women than in diabetic patients [17, 25].
The analysis of our results demonstrated an association between professional activity and illness acceptance. Consistent findings were reported in another study on patients with type 2 diabetes, where professionally active respondents had a higher level of illness acceptance than those who did not work . In our literature review, we also found a report that did not corroborate the correlation between illness acceptance and professional activity in patients with type 2 diabetes .
In previous research on pregnant women with hyperglycemia  and on diabetic patients , respondents who reported better living conditions had better illness acceptance scores. This is consistent with the present findings, where women living in better conditions were also more accepting of the illness-related restrictions in their lives.
Studies on type 2 diabetes patients [17, 36] reported an increase in illness acceptance following diabetes education. As in those studies, in our group, acceptance among women with hyperglycemia during the pregnancy also improved along with self-reported knowledge on lifestyle and treatment and on potential pregnancy complications and health impact. Therefore, diabetes education may be considered as a component of psychological support that can alleviate the negative impact of the illness, thus promoting its acceptance. However, there are studies were diabetic patients receiving education on their illness demonstrated a lower level of illness acceptance than those who did not participate in such interventions . This emphasizes the need to adapt the content and language used in education to the patients’ individual characteristics and their capacity for knowledge assimilation.
Both the present study and other literature reports on hyperglycemic pregnant women  demonstrate an association between illness acceptance and QoL. The higher the patient’s illness acceptance, the better her QoL. Likewise, in diabetic patients studied in Germany , a low level of illness acceptance was also associated with poorer reported QoL.
These findings demonstrate that patients capable of adapting to the difficulties associated with their illness have more positive thoughts, better interpersonal relationships, and a greater sense of physical and psychological security.
Strengths and limitations of this study
The strength of our study lies in the fact that it is one of the very few available studies on illness acceptance, QoL, and their determinants in pregnant women with hyperglycemia. It included a large group of women, lending credibility to the findings. Women with other pregnancy complications, which could affect their perceived QoL and illness acceptance, were excluded from the study.
We are also aware of certain limitations, which could provide some indications for future research. One limitation is the cross-sectional nature of the study, which precludes the establishment of any causal relationships between QoL and hyperglycemia in pregnant women. Future research could include the entire territory of Poland (as our study was only performed in its south-eastern part) and compare QoL and illness acceptance between women first diagnosed with hyperglycemia during pregnancy and those who had had diabetes before their pregnancy.