The attitudes of women with a new diagnosis of gestational diabetes to the required lifestyle changes

By Dr. Priyom Bose, Ph.D.Jan 9 2023Reviewed by Danielle Ellis, B.Sc.

Pregnant women often experience glucose intolerance of varying severity, which is referred to as gestational diabetes (GDM). Several studies have indicated the adverse maternal and perinatal outcomes associated with GDM. For instance, mothers with GDM are at a high risk of developing type 2 diabetes mellitus (T2DM) and the newborn of being obese or experiencing the metabolic syndrome.

Background

Two of the important GDM management measures are exercise and proper diet. These measures are extremely important even for women subjected to oral hypoglycemics or insulin therapy. Exercise before becoming pregnant or during the early pregnancy period provides preventive effects against the development of GDM. Importantly, exercise also controls the glycemic index in women diagnosed with GDM.

Clinicians need to understand the views of women to formulate optimal disease management strategies. This is important because women empowered to manage their health or to make substantial self-care decisions could influence long-term behavior change. Higher success rates in GDM management could be achieved if the preventive measures are supported by society and healthcare professionals.

Most researchers have focussed on how women react to the diagnosis of GDM. These studies also analyzed the mood and quality of life after the diagnosis. A recent The Journal of Maternal-Fetal & Neonatal Medicine study evaluated the attitudes of women newly diagnosed with GDM towards the required lifestyle changes, particularly regarding diet and exercise.

About the study

For the current qualitative study, individuals who attended the Diabetes and Pregnancy service of the National Maternity Hospital (NMH) were invited to participate. Around 800 women in Dublin avail of NHM services.

Women diagnosed with GDM were requested to attend an educational session regarding GDM diagnosis and management. Although most women manage their GDM by modifying their lifestyle, predominantly through diet and exercise, a small number of individuals (around 100 per year) require medical interventions to maintain euglycemia.

A total of thirty-two women participated in the study, among which eighteen were interviewed during pregnancy (antenatal-AN) and fourteen in the postnatal (PN) ward in the days following birth. 

Study findings

Most women in the study cohort believed that their diet was healthy. However, their definition of a healthy diet was a moderate intake of a variety of foods, including sweets. After GDM diagnosis and attending lifestyle education classes, women could detect how they can improve their diet, especially with regards to the portion of food intake. They were happy to change their diet as per the available information and found an improvement in their glycaemic index.

The key initiators to dietary change were the support from the partner and/or family and the concern about the well-being of the fetus. The authors also recognized some factors that inhibited women diagnosed with GDM to follow an appropriate diet, including lack of educational awareness, time, and ignorance. Some women were found to ignore proper lifestyle interventions even after being informed about their benefits.

Time was the primary barrier to meeting the exercise requirement during pregnancy. Nevertheless, before the GDM diagnosis, several barriers to exercise were identified, such as childcare, problems related to time management, and lack of motivation. Unlike following a healthy diet, exercise was more likely to be discontinued in the long term. Although some women considered exercise as a “chore” in managing GDM, those who experienced physical and mental health benefits from regular exercise were great promoters of regular exercise.

After being diagnosed with GDM, most women in the study cohort experienced increased stress and anxiety levels. A varied range of emotions was felt by these women, including anger, shock, and guilt. Two of the important pieces of advice offered by women previously diagnosed with GDM to newly diagnosed women were not to self-blame and to make realistic changes in the diet and regular exercise.

Conclusions and future outlook

The present study uncovers the contrasting attitudes of women newly diagnosed with GDM towards diet and exercise. In the future, more research must be conducted on maintaining lifestyle changes initiated during pregnancy to control GDM. This is important because a healthy diet with physical activity improves an individual's overall health and well-being with a reduced risk of developing chronic diseases.