Abstract
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
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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.