Developing inclusive support for socioeconomically deprived and ethnic minority women with gestational diabetes, to reduce the risk of subsequent type 2 diabetes.

Problem

There is an increasing prevalence globally of women diagnosed with gestational diabetes (GDM), with the burden falling disproportionately amongst women from minority ethnicities and those of low socioeconomic status (1). Women diagnosed with GDM are 7 times more likely to develop type 2 diabetes (T2D) in their lifetime than women with normoglycaemic pregnancies (2). The postpartum period represents an opportunity to intervene, to reduce progression to T2D. Within the UK setting there is a paucity of data exploring lived experiences of GDM, especially amongst women at higher risk, such as those from minority ethnicities, as they are under-represented in existing research (3). This study aimed to understand experiences and make recommendations for primary care, to support women in reducing their progression to T2D.

1. Farrar D et al., Health Technol Assess. 2016;20(86):1–382.

2. Bellamy L et al., The Lancet. 2009;373(9677):1773–9.

3. Pham S et al., BMC Pregnancy Childbirth 2022;22(1):627.

Approach

This was a qualitative interview study. Our recruitment strategy was designed to ensure robust representation of socioeconomically deprived and minority ethnic women. It involved embedding a researcher within Children’s Centres and community services and targeting primary care recruitment in socially deprived areas. Semi-structured interviews were conducted using a theoretically-informed topic guide designed in partnership with patient representatives. The interviews were recorded and professionally transcribed. Thematic content analysis was used to identify key themes, which were verified in data sessions with stakeholders.

Findings

Thirty women were recruited (mean age 36 (SD 5.02), minority ethnicities 66%). Four key themes were identified: We’re left at sea!; I need the GP in my corner; Developing a concrete picture; and Life gets in the way. Women described a feeling of being “left at sea” after the birth, with inconsistent messages accompanying the transition from very active GDM intervention to little support from primary care in the postpartum period. They wanted initial postpartum screening to be embedded in the care pathway at the 8-week check. They expressed a need for the GP to be aware of their GDM, reminding them of HbA1c screening and talking to them about reducing T2D risk. Most women had some awareness but wanted clear, tailored advice to be provided. Women were commonly uncertain about what HbA1c screening measured. Finally, childcare priorities meant that for all women it was hard to focus on their own health postpartum. This was particularly the case for women with depression, living in insecure housing or facing other stresses. Community services, such as Children’s Centres and charities offered vital support for these women and there is potential to develop tailored education and practical activity classes to support behaviour change for mothers accessing these services.

Consequences

Our findings identified recommendations for primary care, that may help these women reduce their subsequent T2D risk.