Perspectives on Prevention of Type 2 Diabetes After Gestational Diabetes: A Qualitative Study of Hispanic, African-American and White Women

Abstract

Women with gestational diabetes (GDM) have a fivefold higher risk of developing type 2 diabetes (T2DM). Furthermore, Hispanic and African-American women are disproportionately affected by GDM, but their views on prevention of T2DM after gestational diabetes are largely unknown. We conducted semi-structured interviews with 23 women (8 Hispanic, 8 African-American, 7 non-Hispanic White) from two academic clinics in Chicago, IL. Interview questions elicited perspectives on prevention of T2DM; the interview protocol was developed based on the Health Belief Model. Two investigators applied template analysis to identify emergent themes. Women conceptualized risk for T2DM based on family history, health behaviors, and personal history of GDM. A subgroup of women expressed uncertainty about how GDM influences risk for T2DM. Women who described a strong link between GDM and T2DM often viewed the diagnosis as a cue to action for behavior change. T2DM was widely viewed as a severe condition, and desire to avoid T2DM was an important motivator for behavior change. Children represented both a key motivator and critical barrier to behavior change. Women viewed preventive care as important to alert them to potential health concerns. Identified themes were congruent across racial/ethnic groups. Diagnosis with GDM presents a potent opportunity for engaging women in behavior change. To fully harness the potential influence of this diagnosis, healthcare providers should more clearly link the diagnosis of GDM with risk for future T2DM, leverage women's focus on their children to motivate behavior change, and provide support with behavior change during healthcare visits in the postpartum period and beyond.

Women's views on lifestyle changes to reduce the risk of developing Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for practice

“…2, 21 articles were included. Table 1 shows the characteristics of these studies, which together represent the views of 926 postpartum women [median (interquartile range) 17 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) participants per study]. Most included face-to-face interviews of women in high-income countries.…”

“…. Conversely, others thought they should role model healthy behaviour, provide healthy food and maintain their own health in order to care for their children: 'I don't [change my eating habits] so much for protecting me from getting diabetes; I do it so that my son, as he is learning to eat, he learns to eat healthier' [26]. but that's mainly so I can do the housework.…”

“…Women in most studies were aware of the link between GDM and Type 2 diabetes but many did not recognize their personal risk [21,25,26,28,29,32,33,[36][37][38], thinking that they could go 'back to normal' [29] rather than make lifestyle changes. Women in most studies were aware of the link between GDM and Type 2 diabetes but many did not recognize their personal risk [21,25,26,28,29,32,33,[36][37][38], thinking that they could go 'back to normal' [29] rather than make lifestyle changes.…”

“…Healthy lifestyle could become less important after pregnancy because it was 'no longer seen as having a direct impact on the child' [25]. Conversely, others thought they should role model healthy behaviour, provide healthy food and maintain their own health in order to care for their children: 'I don't [change my eating habits] so much for protecting me from getting diabetes; I do it so that my son, as he is learning to eat, he learns to eat healthier' [26].…”

“…Perception of diabetes risk varied. Women in most studies were aware of the link between GDM and Type 2 diabetes but many did not recognize their personal risk [21,25,26,28,29,32,33,[36][37][38], thinking that they could go 'back to normal' [29] rather than make lifestyle changes. Some demonstrated a lack of understanding ('I am confident.…”