Gestational diabetes mellitus
Gestational diabetes mellitus (GDM) is a form of diabetes which is first recognised in pregnancy. The prevalence of GDM is increasing and affects around 15% of pregnancies globally. GDM can increase the risk of poor health outcomes for both mum and baby. In the short term, it can lead to babies being larger than average increasing the likelihood of caesarean section. GDM typically resolves after birth, however, it can have long term consequences for both mother and baby including an increased risk of type 2 diabetes in later life.
Management of GDM is demanding on women and involves self-monitoring of blood glucose, diet and exercise modification, and in some cases the use of pharmacological treatment including metformin and insulin. Women will have increased contact with health care professionals and the intensive management of GDM has the potential to change the contextual experience of pregnancy to one that is highly medicalised.
We wanted to explore the psychosocial impacts including experiences of support for women with GDM in the antenatal and postnatal period. We interviewed 33 women with current and past GDM living in the UK.
What we found
We describe six themes from our interviews with women with GDM.
Theme 1: Diagnostic related frustration
Many women described shock and disbelief after receiving their GDM, especially if they didn't see themselves at risk. They often experienced guilt, shame, and self-blame, along with fear for their baby's health and a loss of control. These feelings were worsened by poor communication, unclear diagnostic criteria, and inadequate dietary advice from healthcare providers, leading to confusion and frustration.
“It made me feel like my body wasn’t capable of growing and supporting a baby effectively. That there was something wrong with my biology and it was just all breaking down."
Theme 2: Impact on mental health
Women described considerable strain of GDM on their mental health. Many described management as relentless, exhausting, burdensome, and a stress-inducing process. Many women felt the psychological burden of management was often overlooked by healthcare providers, leading to feelings of isolation and self-blame.
“I was thoroughly miserable… I felt really low. I felt like I couldn’t relax ever, because I had to time when I ate and when I did my finger pricks, and I had to think about all the medications… I was really stressed and really, really low.”
Theme 3: The medicalisation of eating
Dietary changes required for managing GDM had psychological effects on women, including anxiety and stress about food choices and how food would affect blood glucose, and the health of their baby. Changes to their diet also disrupted some women’s relationship with food and triggered previous eating disorders.
“To think about every single thing you put in your mouth and for that it could potentially harm your baby, it’s just an absolute minefield.”
Theme 4: Losing agency to gain control
Women described considerable anxiety and stress related to managing blood glucose levels and feelings of guilt and loss of control when pharmacological treatment was required. Disappointment and frustration with birth conversation were highlighted, as women felt decisions were made for them and not with them.
“...the bit… I found hardest is that sort of like, I need to manage this, otherwise I’m going to be defeated and have to go on medication and that for me was was… a psychological marker of failure.”
Theme 5: Sourcing networks of support
Women reported feelings of isolation and overwhelm because of the number of health professionals involved in their care. Supportive partners and online peer groups played crucial roles in providing emotional and practical assistance, particularly with dietary management and reducing feelings of self-blame and guilt.
“... no one else understands in your life… So just having that support group was so helpful.”
Theme 6: Current pregnancy; and future reproductive health
The postpartum impact of GDM was varied. Some women reported feeling relieved to no longer have GDM, while others reported continued worry and guilt about the increased risk of type 2 diabetes in later life for themselves and their babies. The significant lifestyle changes made during pregnancy continued to affect some women’s mental health and relationship with food postpartum, sometimes leading to trouble eating behaviours and influencing future family planning decisions.
“... there are definitely some feelings of guilt, that I’ve brought him (baby) into the world with this already heightened risk (of diabetes).”