Recommendations for optimising physical activity after gestational diabetes: system targets.

Background

Gestational diabetes increases the risk of developing type 2 diabetes ten-fold postnatally, but physical activity can significantly and independently reduce this risk. Yet most interventions targeting women after gestational diabetes have not been able to change physical activity, despite seeing significant dietary changes or weight loss.

Methods

This study used a realist-inspired approach to produce theory-based recommendations, about what could work to optimise physical activity after gestational diabetes. An advisory group was initiated and guided study conceptualisation, recruitment, data collection and reviewed draft recommendations. The socio-ecological model was used to scaffold theories and create meaningful recommendations at different systems-levels. Theories were generated using systematic reviews and grey literature and were further iteratively tested and refined through qualitative data collection with a wide range of professional stakeholders and people with lived experience. Theory-based recommendations were developed and further refined through consultations with women with previous gestational diabetes, researchers, public health professionals, and Diabetes UK representatives.

Results

Ten final theories were generated. Women need to be empowered, feel supported not just depending on family, have access to co-located and affordable childcare in physical activity spaces and be able to share experiences. The final recommendations spanned across social (n = 3), organisational (n = 6), community (n = 3) and policy (n = 6) levels of the socio-ecological model.

Conclusions

Fundamental patient care requirements must be fulfilled first, as without improvements in continuity of care and dedicated follow-up appointments after gestational diabetes, there is no opportunity to engage in physical activity conversations. Capitalising on existing community and local resources will also be helpful. To access activity spaces, co-located childcare is essential for some women, with further support to tailor physical activity as needed.

What is it about?

The study aimed to develop theory-based recommendations to optimize physical activity (PA) for women post-gestational diabetes mellitus (GDM) by employing a realist-inspired approach. Methodologically, it included forming an advisory group to guide the study's design, data collection, and recommendation review. The socio-ecological model provided a framework for generating and refining theories through systematic reviews and qualitative data from stakeholders and women with GDM experience. The research identified ten theories, emphasizing empowerment, support, co-located childcare, and experience-sharing to enhance PA. The study produced recommendations across social, organizational, community, and policy levels, noting that a multifaceted approach is necessary. It highlighted that addressing fundamental patient care and leveraging community resources are crucial to facilitating PA engagements.

Why is it important?

This study is significant as it addresses the critical public health challenge of reducing the risk of Type 2 Diabetes Mellitus (T2DM) following gestational diabetes mellitus (GDM), which poses a ten-fold increased risk post-pregnancy. The research is pivotal because it develops theory-based recommendations to enhance physical activity (PA) engagement among women who have experienced GDM, a vital component in decreasing T2DM risk. By employing a socio-ecological model and involving diverse stakeholders, the study provides comprehensive, multi-level strategies that can inform policy makers and healthcare providers, thereby improving postnatal care and long-term health outcomes for this high-risk group.

Key Takeaways:

1. Comprehensive Multi-Level Approach: The research highlights that a singular focus is insufficient; instead, a combination of social, organizational, community, and policy-level interventions is necessary to effectively increase PA in women post-GDM, ensuring a holistic improvement in postnatal care.

2. Empowerment and Support: One key finding is the necessity for women to feel empowered and supported through access to affordable childcare and shared experiences in physical activity spaces, enabling them to integrate PA into their daily lives more feasibly.

3. Importance of Continuity of Care: The study underscores the critical need for improved continuity of care and follow-up appointments post-GDM, which are fundamental for initiating and maintaining conversations about PA, thereby facilitating better health outcomes.