PITCH: Views of women with a history of gestational diabetes on reducing risk of developing type 2 diabetes: a systematic review and qualitative synthesis

Problem

Gestational diabetes (GDM) is the most common disorder of pregnancy and the single most important risk factor for the development of type 2 diabetes (T2D). Postpartum health behaviours are strongly associated with T2D risk, yet most women do not attempt or sustain behaviour change and interventions are rarely effective because engagement is poor. Previous qualitative syntheses have explored women’s views on reducing T2D risk as part of broader investigations into women’s experience of GDM. However, no comprehensive review exists. More detailed understanding is needed to inform development and targeting of effective intervention strategies, potentially tailored to women’s experience of GDM. We aim to systematically synthesise the literature focussing on the views of women with a history of GDM on reducing their risk of developing T2D postpartum.

Approach

We searched MEDLINE, Embase, PsychINFO, CINAHL and the Cochrane Library electronic databases in September 2017 as part of a group of literature reviews concerning GDM. Our pre-defined selection criteria include qualitative studies published in peer-reviewed journals that examine women’s postpartum experiences following GDM, views on T2D risk management or experience of a T2D prevention programme. Qualitative data are being analysed in NVivo 11 using thematic synthesis described by Thomas and Harden 2008 in order to develop first descriptive and then analytical themes. We are assessing the quality of each study against the Critical Appraisal Skills Programmes (CASP) checklist for qualitative research, and the extent to which each analytical theme answers our research question using the GRADE-CERQual approach.

Findings

From 23,160 citations, 19 studies meet our inclusion criteria. The median number of participants was 17 and most were interview studies set in high-income countries. Of 15 studies specifying time of data collection, ten were conducted one year or longer after the GDM-affected pregnancy. Three studies collected data on more than one postpartum occasion. Our analysis to date has identified preliminary themes concerning experienced and anticipated barriers and facilitators to postpartum healthy diet, physical activity and engagement in a T2D risk reduction programme, along with eliciting women’s views on the ‘ideal’ programme. For instance, family is a key feature of each theme and can act as both a barrier (for example, not wanting to leave children alone) and facilitator (for example, wanting to attend classes in order to provide healthy family meals) to healthy postpartum lifestyle.

Consequences

Our study will synthesise current understanding and identify key uncertainties concerning the views and needs of women with previous GDM regarding T2D prevention strategies, and the acceptability, feasibility and practicality of postpartum interventions. This will inform the development of interventions, or adaption of existing ones, to educate and support women in maintaining a healthy postpartum lifestyle in order to reduce their risk of developing T2D.