Research Review: Preventing type 2 diabetes in women after a pregnancy with gestational diabetes

During the summer break from my medical studies, I had the opportunity to lead a qualitative research study, exploring the enablers and challenges to maintaining a healthy lifestyle following Gestational Diabates. The research was based in Wellington and supervised by Associate Professor Rosemary Hall, an Endocrinologist at TWO Capital, Coast and Hutt Valley and Clinical Lead of the Diabetes in Pregnancy Service. The research team also included Professor Jeremy Krebs, Endocrinologist, and Dr Christine Barthow, Senior research fellow. I want to acknowledge the participants who generously gifted their time, knowledge and experiences to this study. I also extend my appreciation to the research team for their support and to the NZSSD-DNZRF for funding this project.

As part of this project, I conducted interviews with health professionals and wāhine enrolled at Porirua Union and Community Health Service, a primary practice supporting one of the most socioeconomically underserved communities within the Wellington region. Our research explored the experiences of mothers and their whānau following a pregnancy affected by gestational diabetes, with the aim of understanding what helps, and what makes it more difficult, to maintain a healthy lifestyle after pregnancy.

 Gestational diabetes is a common condition that develops during pregnancy, and disproporiately affects Māori, Pacific, and South Asian wāhine in Aotearoa New Zealand. Wāhine who have had gestational diabetes are at a much higher risk of developing type 2 diabetes later in life, however, healthy lifestyle changes can meaningfully reduce this long term risk. Local research emphasises that the most effective programs which support lifestyle change are community delivered, culturally appropriate and tailored to a person’s individuals experience and needs. For this reason, we sought to better understand the personal, family, cultural and wider societal factors that influence health and lifestyle following gestational diabetes. These insights will help guide the development of strategies which work to support wāhine and their whānau to stay healthy and reduce their risk of developing type 2 diabetes.  

We found that while strong support is provided for wāhine during their pregnancy with gestational diabetes, this often drops away after birth, even though the risk of developing type 2 diabetes continues to rise. Our results show that life after gestational diabetes is shaped by intersecting social, cultural, environmental and health system factors that create complexity when trying to prioritise and sustain healthy habits. Building on this, effective support strategies must be grounded in the lived realities of mothers and their whānau, working to address challenges and strengthen enablers identified in this study. 

My personal highlight was having the privilege to meet with and hear the lived experiences of some incredible people within my community. I believe that the key to providing person-centred and culturally appropriate healthcare is to first ask and listen to the people we hope to support. I was inspired to hear their kōrero, learn from their perspectives and create research that hopes to support meaningful improvements in health outcomes for wāhine and their whānau. My research is grounded in producing insights relevant to the people of Aotearoa New Zealand and aligned with the principles of Te Tiriti o Waitangi, ensuring it addresses and reduces health inequities, supporting all Kiwis to live healthy lives.