How can we improve engagement with gestational diabetes self-management guidance and lifestyle change during pregnancy and beyond? A thematic analysis amongst a diverse sample of UK women

Abstract Background Optimal management of gestational diabetes (GDM) during in pregnancy is important because of serious risk to mother and child in cases where glucose levels are poorly controlled. Furthermore, following a GDM pregnancy up to 50% of women in some populations will go onto develop type 2 diabetes (T2D) later in life. A risk which is 10 times higher than for women who have a normoglycaemic pregnancy and which can be reduced by lifestyle change and annual screening. This study is needed because there is a paucity of data from the UK setting exploring these factors amongst ethnically diverse women and there has also been a fundamental shift towards online care provision and use of apps in maternity care in recent years, which may influence how women engage with self-management. The aim of our study was to explore experiences and identify factors which could help women engage with GDM self-management guidance during pregnancy and with T2D risk prevention strategies postpartum, amongst a diverse sample of UK women. Methods Women were recruited from the community and targeted primary and secondary care settings to take part in an online or face to face qualitative interview. Community recruitment was prioritised to encourage engagement of women who may not normally access the research process. Interviews were audio-recorded and professionally transcribed. An inductive thematic content analysis was conducted. Results Thirty-five women took part in the interviews (66% were from minority ethnicities; 43% first-generation immigrants). Factors influencing engagement with pregnancy guidance were summarised in 6 themes: a psychological burden, for your baby you find a way, coping with the everyday, building resilience, the service provision, relational interactions, and with postpartum guidance: left at sea. Conclusions The use of apps, online peer support groups, personally-tailored lifestyle advice and empathetic online or face to face healthcare interactions, supported GDM self-management. Postpartum knowledge about the risks and useful steps for diabetes prevention was low and confusion was exacerbated by mixed messages from healthcare teams. Some women may benefit from community-situated peer support and culturally salient guidance.