“Post-GDM support would be really good for mothers”: A qualitative interview study exploring how to support a healthy diet and physical activity after gestational diabetes

Abstract

Background Women with a history of gestational diabetes mellitus (GDM) are at high risk of developing type 2 diabetes mellitus (T2DM). They are therefore recommended to follow a healthy diet and be physically active in order to reduce that risk. However, achieving and maintaining these behaviours in the postpartum period is challenging. This study sought to explore women’s views on suggested practical approaches to achieve and maintain a healthy diet and physical activity to reduce T2DM risk. Methods Semi-structured interviews with 20 participants in Cambridgeshire, UK were conducted at three to 48 months after GDM. The participants’ current diet and physical activity, intentions for any changes, and views on potential interventions to help manage T2DM risk through these behaviours were discussed. Framework analysis was used to analyse the transcripts. The interview schedule, suggested interventions, and thematic framework were based on a recent systematic review. Results Most of the participants wanted to eat more healthily and be more active. A third of the participants considered that postpartum support for these behaviours would be transformative, a third thought it would be beneficial, and a third did not want additional support. The majority agreed that more information about the impact of diet and physical activity on diabetes risk, support to exercise with others, and advice about eating healthily, exercising with a busy schedule, monitoring progress and sustaining changes would facilitate a healthy diet and physical activity. Four other suggested interventions received mixed responses. It would be acceptable for this support to be delivered throughout pregnancy and postpartum through a range of formats. Clinicians were seen to have important roles in giving or signposting to support. Conclusions Many women would appreciate more support to reduce their T2DM risk after GDM and believe that a variety of interventions to integrate changes into their daily lives would help them to sustain healthier lifestyles.

The effectiveness of pharmacological and lifestyle interventions to reduce the risk of diabetes and hyperglycaemia following gestational diabetes: A systematic review and meta‐analysis

“…Unlike pharmacological interventions that cease when the intervention ends (that is, treatment is removed), lifestyle interventions may lead to changes in diet and physical activity that can be maintained after the study. Although the postpartum period may be a more appropriate time to learn and establish new routines, 12,39 and previous reviews have highlighted greater effectiveness for interventions that start after delivery, 18,19 this may explain why we did not observe significant differences according to timing relative to pregnancy. Prompted by recommendations based on a qualitative synthesis, we have previously identified a wide range of intervention elements that may help to support women to reduce their T2DM risk by making changes to their diet and physical activity 12 .…”

“…Women with GDM are encouraged to maintain healthy lifestyles during and after pregnancy, in particular to establish a healthy BMI through being physically active and eating healthily. However, most women exhibit discordant T2DM risk perception and behaviour, and need more support to achieve and sustain such changes 11–13 …”

Perceptions of Chinese women with a history of gestational diabetes regarding health behaviors and related factors: a directed qualitative content analysis

“…In particular, as we have shown in the present study, spouses with a high level of health awareness often accompany women and encourage them to do physical exercise, which is regarded as a strong incentive to achieve a healthy lifestyle [ 38 ]. In addition, peers can build a mutual aid system by sharing experiences and motivating one another [ 43 ], which empowers patients with diabetes to improve their self-efficacy [ 44 ]. In the present study, some women suggested the setting up of a WeChat group to share knowledge and skills regarding diabetes, based on their own personal experiences, a finding that was also made in another qualitative study [ 43 ].…”

“…In addition, peers can build a mutual aid system by sharing experiences and motivating one another [ 43 ], which empowers patients with diabetes to improve their self-efficacy [ 44 ]. In the present study, some women suggested the setting up of a WeChat group to share knowledge and skills regarding diabetes, based on their own personal experiences, a finding that was also made in another qualitative study [ 43 ]. This provides a reference for us to formulate more targeted and effective strategies to assist this high-risk population.…”

Screening and nursing management of gestational diabetes in Ghana: Evidence-based recommendations

“…Further, consistent engagement of midwives with woman's significant others, including family members, a partner, friends or colleagues, and involving them in counselling, education and feedback during the management process needs to be considered. The involvement of relatives was mentioned by other researchers as a source of support and complimentary care from significant others has been reported to be sought by women diagnosed with GDM [ 43 , 44 ]. Social support in the management of GDM was identified as crucial for effective glycaemic control [ 45 ].…”