Doran, FM 2010, 'An exploratory study of physical activity and lifestyle change associated with pregnancy and gestational diabetes mellitus and the implications for health promotion interventions', PhD thesis, Southern Cross University, Lismore, NSW.
Copyright FM Doran 2010
This research was an exploratory study of physical activity, pregnancy and Gestational Diabetes Mellitus (GDM) with implications for health promotion interventions. The study aimed to explore women’s physical activity levels before, during and after pregnancy including women who experienced GDM; factors that influenced levels of physical activity; women’s attitudes and information received in relation to physical activity; the influence of a diagnosis of GDM on a woman’s life; any subsequent lifestyle changes made to manage GDM during pregnancy and to prevent the progression to Type 2 diabetes postpartum. Interpretive constructivist gendered health promotion was the methodological framework of the research which utilised a mixed methods design.
The research was conducted in three main stages. Stage 1 was a qualitative exploration of physical activity in relation to pregnancy and GDM. Methods used were focus groups and individual interviews. Participants included Indigenous women, women from the Pacific Islands, women in Tonga who developed GDM, and health professionals in Tonga who worked in the GDM & diabetes area. Stage 2, the quantitative stage, included a survey on physical activity and pregnancy, a survey on GDM, and a seven-day physical activity diary. Stage 3 involved in-depth interviews with Australian women who developed GDM.
Results indicated that moderate-intensity physical activity was viewed as beneficial before, during and after pregnancy and for the management of GDM but, in general, women’s participation in moderate physical activity across all stages was low. Walking was the most common type of physical activity at all stages. Walking slowly was the only activity that increased during pregnancy compared to before pregnancy and this finding adds to the body of knowledge in this area. Factors that supported women to engage in physical activity during and after pregnancy related to perceived personal physical and psychological benefits and barriers were associated with external constraints such as lack of time and lack of childcare. In relation to GDM, lifestyle changes to diet and physical activity made during pregnancy as a result of a diagnosis of GDM were difficult to sustain after the baby was born, despite women’s awareness of their increased risk of developing future Type 2 diabetes.
Attention to physical activity as a component of antenatal care for women in this study was lacking. During pregnancy, minimal attention was given to physical activity by their health care providers, despite frequent interaction with the health care system. Few women reported being advised by their health providers to engage in regular or more physical activity during their antenatal visits. However, there was a significant statistical difference between women who developed GDM compared to those without GDM; the former were advised to engage in physical activity as part of the management of GDM. Postpartum follow-up screening was low. Postpartum screening and ongoing lifestyle support in this group of women was virtually absent. Women who develop GDM are at a high risk of developing Type 2 diabetes and there is a gap in follow-up care and support for this group of women.
Women may be missing out on the benefits of physical activity during and after pregnancy, especially those women who develop GDM. There is an opportunity for health care providers to develop empowering partnerships with pregnant women and to develop strategies to enable women to participate in physical activity with a consideration of the factors that both support and hinder women’s participation in physical activity. Recommendations reflective of a gendered approach to health promotion which consider the social determinants of health are proposed.