Perceptions on Diet and Dietary Modifications during Postpartum Period Aiming at Attenuating Progression of GDM to DM: A Qualitative Study of Mothers and Health Care Workers

Abstract

Background Gestational diabetes mellitus (GDM) is a global concern. GDM mothers have a 7-fold relative risk of developing type 2 diabetes mellitus (T2DM) in their later life. User-friendly and culturally acceptable dietary interventions can minimize this risk. Therefore, this study aims at exploring the perceptions of GDM mothers and health care workers regarding factors that influence postpartum dietary practices aimed at attenuating the trajectory from GDM to DM. Methods The study was conducted in selected MOH areas in three districts of Sri Lanka. Six focus group discussions were conducted with thirty mothers with a history of GDM and six in-depth interviews with six health care workers. The phenomenon of interest was to obtain inputs of two stakeholder groups on healthy food habits of GDM mothers during the postpartum period. Framework analysis was used to analyse the data. Data were coded using the analytical framework, abstracted from transcripts, and summarized verbatim in Microsoft Excel in a matrix comprised of one row per participant and one column per code. Finally, the matrix was reviewed intensely and themes were generated. Results Overall, seven themes emerged from both cases: (1) myths and traditions specific to the postpartum period, (2) lack of motivation, (3) time pressure, (4) financial barriers, (5) negligence of mothers and families, (6) lack of awareness regarding GDM and its postpartum dietary recommendations, and (7) cultural barriers. Conclusions This study provides an insight into the existing knowledge, common practices, and attitudes regarding food habits among postpartum mothers with a history of GDM. Since the postpartum period is unique, identifying barriers is crucial when introducing dietary modification protocols in order to prevent or attenuate the progression of GDM to T2DM in these mothers. The knowledge gained will be used to introduce feasible, scientifically sound, and culturally acceptable postpartum dietary recommendations for GDM mothers.

Barriers and facilitators to a healthy lifestyle in postpartum women: A systematic review of qualitative and quantitative studies in postpartum women and healthcare providers

“…Twenty‐five studies reported on women's perspectives and three on HPs' perspectives. Ten studies were conducted in United States, 32–41 six in Australia, 42–47 three in United Kingdom, 48–50 two each in Hawaii 51,52 and Netherlands 53,54 and one each in New Zealand, 55 Canada, 56 Norway, 57 Mexico 58 and Sri Lanka 59 . Seven studies reported on women who had previously had high risk pregnancies including gestational diabetes mellitus (GDM), pre‐eclampsia and postnatal depression.…”

“…Lacking knowledge on when to safely resume exercise after childbirth and the health consequences of pregnancy complications were barriers for postpartum women especially in those who had a pregnancy complicated by GDM or pre‐eclampsia 44,49,54 . Similarly, HPs believed that women were unaware of the benefits of physical activity, the importance of postpartum dietary modifications and weight control in reducing future risk of type 2 diabetes 50,58,59 . In one study, HPs themselves reported lacking knowledge of the relationship between GDM and diabetes mellitus (DM) and the role of dietary habits in the progression of GDM to DM 59 …”

Preventing Type 2 Diabetes in Women with Previous Gestational Diabetes: Reviewing the Implementation Gaps for Health Behavior Change Programs

“…64,65 Following childbirth, the woman's focus shifts from her health to her child's well-being. 47,66 The reprioritization to child and family commitments over personal health creates challenges for mothers in making time for exercise or preparing healthy meals for themselves. 53,[66][67][68] Family members could pose a further barrier by being unsupportive of healthy meals.…”

“…47,66 The reprioritization to child and family commitments over personal health creates challenges for mothers in making time for exercise or preparing healthy meals for themselves. 53,[66][67][68] Family members could pose a further barrier by being unsupportive of healthy meals. 51,68 Cultural or self-derived expectations also lead to postpartum women feeling guilty taking time out for selfcare.…”

Chinese Women’s Attitudes Towards Postpartum Interventions to Prevent Type 2 Diabetes After Gestational Diabetes: A Semi-Structured Qualitative Study

“…Whilst invitation to the study was done by doctors not involved in this research, the study sample from both urban and rural population was generally representative of women with GDM in this region. Moreover, the sample size was su cient to provide saturation of themes (20). However, fewer women were recruited from SLH, and all these women were interviewed during prenatal period.…”