(224) “A wake-up call”: A mixed methods analysis of diabetes prevention after gestational diabetes

Gestational diabetes (GDM) is a common adverse pregnancy outcome that increases risk of type 2 diabetes (T2D). Optimizing lifestyle choices, such as increasing physical activity and healthy eating behaviors, in the postpartum period is recommended to prevent T2D. The objective of this analysis was to identify patient perspectives on incorporating such lifestyle choices throughout the first postpartum year.

Study Design:

This is a mixed methods analysis of data from individuals with GDM who completed surveys and in-depth interviews at 11-13 months postpartum as part of their participation in a randomized controlled trial on postpartum patient navigation. Surveys (structured items with a Likert scale) and interviews queried participants regarding barriers and facilitators to postpartum T2D prevention. We used a concurrent, triangulation design to jointly analyze interview data (via constant comparative method) alongside survey data.

Results:

Of 40 participants, 39 (49% publicly insured) provided data about T2D prevention activities. Emergent themes from interviews triangulated with survey results to yield consistent insights about physical activity (Fig 1) and healthy eating (Fig 2). The majority reported that caring for a new baby (64%) and family responsibilities (58%) made it much harder to be physically active, while fewer participants identified cost of exercise, accessing a safe space to exercise, or breastfeeding as barriers. Similarly, the most common barriers to eating healthy included caring for a new baby (36% much harder), family responsibilities (33% much harder), and work/school schedules (33% much harder). Although proximity and transportation to healthy food sources were uncommonly rated barriers, when they did occur, participants experienced significant barriers with achieving nutrition recommendations.

Conclusion:

Individuals who had GDM reported many barriers to implementing lifestyle choices that are recommended as strategies to reduce the risk of developing T2D. Recognizing these unique needs may support provision of realistic and feasible guidance for T2D prevention postpartum.