“I wasn’t expecting to have it”: Constructions of risk in women with gestational diabetes (GDM)

Background: GDM is the commonest medical disorder of pregnancy and affects 5-18% of pregnancies. Women with GDM face increased risks including pre-eclampsia, birth-related trauma, and future Type 2 diabetes; their children are at greater risk of macrosomia, birth injury, perinatal death and future obesity. National guidelines in England recommend testing women with known risk factors (i.e. previous history of GDM, first-degree relative with diabetes, maternal BMI > 30, previous baby ≥ 4.5kg at birth, ethnic origin) with a glucose tolerance test at 24-28 weeks. Diet and lifestyle advice is the primary management strategy. Aim: To examine women’s constructions of GDM and the wider context within which dietary management is performed. Method: Women (n=107) recruited from diabetes antenatal clinic to use myfood24, an online dietary self-assessment tool, were invited to be interviewed about their experiences of managing GDM. Interviews were conducted at 27-37 weeks’ gestation (n=13) or early postpartum (n=2). Three women had a history of GDM, six had had previous pregnancies unaffected by GDM and six were first-time mothers. Data was analysed by three researchers using thematic analysis. Results: Thirteen women had known risk factors, including nine with diabetes in a first-degree relative, yet most reported little awareness of GDM at the point of testing. Women consistently described ‘shock’ at their (first) diagnosis and not having considered themselves ‘at-risk’. In describing their motivations to manage their GDM, most focused on their baby’s size and concerns about the birth; a minority voiced concerns about long-term risks of themselves developing diabetes. Interpretation: Despite being tested for GDM based on risk factors identified at the first ‘booking’ antenatal appointment, women may not be prepared for their diagnosis. Conclusion: Changes to maternity care are needed to educate women about GDM at booking, prepare them for testing and encourage early adoption of positive health behaviours.