Narratives of Gestational Diabetes Provide a Lens to Tailor Postpartum Prevention and Monitoring Counseling

Abstract

Introduction: Women with gestational diabetes mellitus (GDM) have a marked increased risk of early onset type 2 diabetes, but less than half initiate postpartum glucose testing or connect with a primary care provider for continued follow-up after giving birth. This study analyzed women's narratives about their GDM-affected pregnancies to (1) identify different patterns (narrative archetypes) that capture the GDM experience; (2) explore how these patterns relate to awareness of ongoing risk after pregnancy and affect participation in self-care, monitoring, and preventive health care going forward; and (3) explore the use of identified patterns to tailor conversations with patients during prenatal and postpartum care to their actual perceptions and concerns about future risk. Methods: Open-ended interviews elicited women's experiences and perspectives about GDM and its management. A narrative analysis first identified segments of text related to risk and behaviors and then applied Frank's narrative archetypes (restitution, chaos, quest) as an interpretive lens. Results: Interviews were completed in English (n = 15), Spanish (n = 7), and Haitian Creole (n = 7). We found distinct patterns: stories of restitution (n = 13), quest (n = 4), chaos (n = 4), and mixed narratives (n = 7). Using these archetypes, we found differences in how women respond to challenges related to disease complexity, treatment, and future risks. These patterns led to marked differences in the steps women took to prevent early onset type 2 diabetes. Discussion: Frank's narrative types provided insight into women's responses to clinical protocols, health care advice, and subsequent prevention actions. A restitution pattern may result in premature closure and lack of awareness of risk. Similarly, a chaos pattern may contribute to a sense of helplessness to implement follow-up recommendations, despite risk awareness. Understanding these patterns can help clinicians tailor individualized support as women transition from GDM with its focus on a healthy fetus and newborn to preventive self-care to protect their health.

Barriers to and enablers of type 2 diabetes screening among women with prior gestational diabetes: A systematic review update and qualitative synthesis applying the Theoretical Domains Framework

“…While awareness of the need for screening was typically high, lack of awareness of a link between gestational diabetes and future type 2 diabetes risk was a key barrier. Many studies highlighted women's perceptions of gestational diabetes as ‘an acute phenomenon…confined to pregnancy’, 49 prompting one author to recommend that ‘interventions are needed to raise postpartum diabetes risk awareness’ 54 . Relatedly, women reported confusion about the risk of conversion to type 2 diabetes: ‘You've got the glucose intolerance test, but I don't know how far after that people would develop diabetes’ 55 .…”

“…In three cases, more than one paper described the same study and reported different outcomes. For each instance, we nominated the study as the unit of interest 43 and the earliest publication as the primary source 44–46 retaining the secondary papers 47–50 …”

Barriers to and enablers of postpartum health behaviours among women from diverse cultural backgrounds with prior gestational diabetes: A systematic review and qualitative synthesis applying the theoretical domains framework

“…We nominated the study as the unit of interest, 59 the earliest publication 60 , 61 , 62 as the primary source and retained the secondary papers. 63 , 64 , 65 …”

“…Some women believed GDM was ‘confined to pregnancy’ and were unaware of future risks. 60 , 62 , 63 , 65 , 77 For them, risk beyond the immediate postpartum period was not a concern. 60 , 63 , 77 Thus, ‘many reverted to previous diet habits … and did not engage in … prevention activities’.…”

The Fourth Trimester: a Time for Enhancing Transitions in Cardiovascular Care

“…Although GDM pharmacotherapy generally can be stopped after delivery, the American Diabetes Association recommends regular glucose monitoring starting a few days after delivery, at 2–6 months postpartum and every 1–3 years thereafter [ 42 ]. Open-ended interviews conducted with women with GDM revealed that many women considered GDM as an acute, resolvable condition that does not require further surveillance and worry and only a small minority considered it a wake-up call for continuing healthy lifestyle [ 43 ]. Understanding this narrative can help clinicians better communicate with affected women to improve transition in care after delivery.…”