Preconception perceptions, knowledge and behaviours of women with gestational diabetes mellitus: a qualitative study

Abstract

BACKGROUND: Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. While considerable attention has been paid to the management of GDM during pregnancy, women's perceptions of GDM, knowledge of associated risk factors and health behaviours before and between pregnancies are less well understood, despite their importance for informing diabetes prevention programmes.

AIMS/OBJECTIVES: To explore women's knowledge of GDM risk factors, perceptions of GDM and preconception health behaviours.

METHODS: Individual semi-structured interviews were undertaken with 23 women with GDM in the third trimester of pregnancy. Data were analysed using a template analysis based on preconception knowledge, risk communication, and perceptions and behaviours.

RESULTS: Women often had limited knowledge of GDM before pregnancy, with many first learning about the condition during antenatal screening. Perceptions of risk were largely weight or BMI centred, with less recognition of other factors. Although participants commonly described intentions to improve diet quality and increase physical activity prior to conception, these intentions were rarely translated into sustained behaviours. Reported barriers included time constraints, caregiving responsibilities, financial costs and limited access to clear, culturally appropriate guidance. Pregnancy preparedness varied by parity: women approaching a first pregnancy focused on general preparation and navigating the healthcare system, whereas women with a prior GDM experience planned around potential recurrence, including early self-management and glucose monitoring.

CONCLUSIONS: Findings support two priorities: (1) strengthening communication and education at the time of GDM screening and diagnosis so that results and next steps are clear, supportive and person-centred; and (2) providing universal, general preconception support delivered proportionately to need, alongside targeted interconception pathways for women at higher absolute risk, following GDM. The findings do not imply universal GDM-specific preconception education for all women; rather, they indicate a need for needs-based communication during pregnancy and targeted interconception support delivered with clear signposting to resources.

PATIENT OR PUBLIC CONTRIBUTION: An advisory group of seven women has been involved in this project. Four online sessions were conducted (between October 2023 and July 2024) to develop the research question, study materials, recruitment plans, interview schedules and participant retention plan.

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