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

Abstract

Aims After gestational diabetes, many women exhibit behaviours that increase their risk of developing Type 2 diabetes. We aimed to systematically synthesize the literature that focuses on the views of women with a history of gestational diabetes on reducing their risk of developing diabetes postpartum through lifestyle and behaviour changes. Methods We identified qualitative studies that examined the views of women with a history of gestational diabetes towards healthy eating and physical activity, Type 2 diabetes risk management or their experience of a diabetes prevention programme, and conducted a thematic synthesis to develop descriptive and then analytical themes. We also evaluated the quality of each study and the confidence that we had in our findings. Results We included 21 articles after screening 23 160 citations and 129 full texts. We identified six themes of interacting influences on postpartum behaviour: role as mother and priorities; social support; demands of life; personal preferences and experiences; risk perception and information; and finances and resources (plus preferred format of interventions). These factors inhibited many women from addressing their own health, while they motivated others to persevere. We also developed 20 recommendations, most with high or moderate confidence, for effective promotion of healthy lifestyles in this population. Conclusions Many factors hinder healthy lifestyles after gestational diabetes, yet how women interpret them can motivate or prevent changes that reduce diabetes risk. As our recommendations emphasize, women's experiences and needs should be considered when designing strategies to promote healthier lifestyles in this population.

Recommendations for promoting healthier lifestyles in postpartum women after gestational diabetes

“…Our meta-analysis did not find a significant effect on other intervention characteristics such as format of delivery, intensity or duration [6]. This aligns with Dennison et al who described mixed responses on these characteristics [1]. The Consolidated Framework for Implementation Research (CFIR) [7] describes interventions as having core components and adaptable periphery.…”

“…We read with interest the study by Dennison et al [1] which provided a qualitative synthesis on the facilitators and barriers to lifestyle changes from the perspective of women with recent gestational diabetes (GDM). We would like to provide some additional insights from our own work.…”

“…We now need to progress the efficacy evidence into broader effectiveness by focusing on the 'how'. To address this, Dennison et al [1] proposed 20 recommendations mapped against behaviour change techniques (BCT) based on the perceived needs of the women. Consideration of end-users' perspectives is critical in implementation researchwe would like to commend the authors' effort in doing so.…”

The Feasibility and Preliminary Efficacy of an eHealth Lifestyle Program in Women with Recent Gestational Diabetes Mellitus: A Pilot Study

“…Women with a history of GDM experience substantial barriers to adopting healthy lifestyle behaviours, including carer responsibilities, poor timing of education and fragmented care as well as additional cultural barriers for women born overseas [ 54 , 55 ]. While intensive lifestyle interventions are effective at delaying or preventing progression to diabetes [ 12 ], such interventions require extensive resources and support.…”

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

“…22 Systematic reviews have identified the need for specific, tailored, and empathic conversations about the complexities of managing GDM in the context of everyday life and available supports. 9,20,21 To date, however, findings have not fully characterized how women's perceptions, shaped during the prenatal period, affect postpartum behaviors. The current study seeks to describe women's narratives about their GDM experience and how these narratives guide their actions after birth.…”