Gestational Diabetes Mellitus (GDM) is strongly associated with the future risk of type 2 diabetes mellitus (T2DM). Women with GDM have a 10 times higher risk than women without GDM over a 10-year follow-up period. The objective of this review is to synthesise the existing evidence regarding women’s views and experiences of the emotional and practical impact of GDM and its implications for diabetes prevention. Findings will be used to inform the design of interventions to prevent or delay T2DM. A systematic review of qualitative studies was conducted searching PubMed, MEDLINE, Science Direct, Scopus, and PsycINFO, from 2010 to 2021. Studies were eligible if they addressed how women’s experiences and perceptions of GDM influenced women’s adherence to postpartum follow-up and lifestyle interventions. The Social-Ecological Model guided the data analysis including five levels of influence specific to health behaviour: intrapersonal factors, interpersonal factors, health system organisational factors, public policy and environmental factors, and community factors. We included 31 articles after screening 22 943 citations and 51 full texts. We found that women’s role as mother and caregiver is competing with one’s own health priority resulting in poor postpartum screening and poor management of eating and physical activity behaviours. A supportive environment including partners, family, peers and health professionals is essential for lifestyle changes. Other environmental factors such as limited financial means or lack of health education were also barriers to adopting a healthy lifestyle. Many factors hinder T2DM postpartum screening and healthy lifestyle behaviours after GDM, yet the postpartum period is an opportunity to improve access to diabetes prevention, care and education. Women’s experiences and needs should be considered when designing strategies and interventions to promote healthier lifestyles in this population. (Afr J Reprod Health 2023; 27 [5s]: 96-109).

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outcome in gestational diabetes mellitus in a Tertiary

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gestational diabetes through primary health care

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and IDF Diabetes Atlas Committee Hyperglycaemia

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in Pregnancy Special Interest Group. IDF Diabetes

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Atlas: Estimation of Global and Regional Gestational

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Diabetes Mellitus Prevalence for 2021 by

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International Diabetes Federation. Brussels,

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women’s preventive healthcare. BMJ Open Diabetes

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Li Z, Cheng Y, Wang D, Chen H, Chen H, Ming WK and

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after Gestational Diabetes Mellitus: A Systematic

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Diabetes Res [Internet]. 2020 [cited 2021 May

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Song C, Lyu Y, Li C, Liu P, Li J, Ma RC and Yang X.

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Long-term risk of diabetes in women at varying

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durations after gestational diabetes: a systematic

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review and meta-analysis with more than 2 million

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women. Obes Rev. 2018;19(3):421–9.

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Hinkle SN, Buck Louis GM, Rawal S, Zhu Y, Albert PS

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and Zhang C. A longitudinal study of depression and

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gestational diabetes in pregnancy and the postpartum

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period. Diabetologia [Internet]. 2016 Dec 1 [cited

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Nicklas JM, Miller LJ, Zera CA, Davis RB, Levkoff SE and

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Seely EW. Factors associated with depressive

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symptoms in the early postpartum period among

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women with recent gestational diabetes mellitus.

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Matern Child Health J [Internet]. 2013 Nov [cited

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Santos WM Dos, Secoli SR and Püschel VA de A. The

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Joanna Briggs Institute approach for systematic

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reviews. Rev Lat Am Enfermagem. 2018;26:e3074.

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WHO Regional Office for Europe. Guide to qualitative

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evidence synthesis: evidence-informed policymaking using research in the EVIPNET framework

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Hróbjartsson A, Lalu MM, Li T, Loder EW, MayoWilson E, McDonald S, McGuinness LA, Stewart

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LA, Thomas J, Tricco AC, Welch VA, Whiting P and

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Moher D. The PRISMA 2020 statement: An updated

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Vol. 372, The BMJ. British Medical Journal

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Publishing Group; 2021 [cited 2022 Apr 20].

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Tong A, Flemming K, McInnes E, Oliver S and Craig J.

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Enhancing transparency in reporting the synthesis of

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Critical Appraisal Skills Programme. CASP Qualitative

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Research Checklist [Internet]. Critical Appraisal

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Skills Programme (CASP). 2018 [cited 2022 Nov

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Aromataris E, Munn Z. JBI MANUAL FOR EVIDENCE

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SYNTHESIS. JBI; 2020.

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Mcleroy KR, Bibeau D, Steckler A and Glanz K. An

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ecological perspective on health promotion

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programs. Health Educ Q [Internet]. 1988 [cited

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Thomas J and Harden A. Methods for the thematic

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synthesis of qualitative research in systematic reviews. BMC Med Res Methodol [Internet]. 2008

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Jul 10 [cited 2022 Oct 4];8(1):1–10. Available

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m/articles/10.1186/1471-2288-8-45

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Muhwava LS, Murphy K, Zarowsky C and Levitt N.

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Experiences of lifestyle change among women with

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gestational diabetes mellitus (GDM): A behavioural

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diagnosis using the COM-B model in a low-income

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setting. PLoS One [Internet]. 2019 Nov 1 [cited 2022

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Whitty-Rogers J, Caine V and Cameron B. Aboriginal

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women’s experiences with gestational diabetes

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mellitus a participatory study with Mi’kmaq women

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Abraham K and Wilk N. Living with gestational diabetes

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in a rural community. MCN Am J Matern Nurs

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Zulfiqar T, Lithander FE, Banwell C, Young R, Boisseau

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L, Ingle M and Nolan CJ. Barriers to a healthy

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lifestyle post gestational-diabetes: An Australian

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qualitative study. Women and Birth [Internet]. 2017

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Razee H, Van Der Ploeg HP, Blignault I, Smith BJ,

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Bauman AE, McLean M and Cheung NW. Beliefs,

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barriers, social support, and environmental

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influences related to diabetes risk behaviours among

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Kilgour C, Bogossian FE, Callaway L and Gallois C.

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postpartum experience of Danish women following

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gestational diabetes? A qualitative exploration.

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Lie MLS, Hayes L, Lewis-Barned NJ, May C, White M and

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Bell R. Preventing type 2 diabetes after gestational

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diabetes: Women’s experiences and implications for

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diabetes prevention interventions. Diabet Med

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Parsons J, Sparrow K, Ismail K, Hunt K, Rogers H and

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Forbes A. Experiences of gestational diabetes and

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gestational diabetes care: A focus group and

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interview study. BMC Pregnancy Childbirth.

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DM, Nicholson WK and Clark JM. Barriers to and

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facilitators of postpartum follow-up care in women

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qualitative study. In: Journal of Women’s Health

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Oklahoma, 2012-2013. Prev Chronic Dis [Internet].

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improving care of Australian Aboriginal and Torres

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Modifications during Postpartum Period Aiming at

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Workers. J Diabetes Res [Internet]. 2018 [cited 2022

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Prevention of Type 2 Diabetes After Gestational

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Diabetes: A Qualitative Study of Hispanic, AfricanAmerican and White Women. Matern Child Health J

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Nielsen JH, Olesen CR, Kristiansen TM, Bak CK and

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diabetes. Women and Birth [Internet]. 2015 Dec 1

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lifestyle information in women with gestational

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diabetes: A pilot study before and after delivery. Eur

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Sharma M, Purewal TS, Fallows S and Kennedy L. The

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low-risk perception of developing type 2 diabetes

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among women with a previous history of gestational

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diabetes: a qualitative study. Pract Diabetes

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Gunn C, Bernstein J, Bokhour B and McCloskey L.

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Tailor Postpartum Prevention and Monitoring

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Counseling. J Midwifery Women’s Heal [Internet].

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Bagger S, Maindal HT, Nielsen KK and Vrå AG, AagaardHansen J. Perceptions of risk and motivation for

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healthy living among immigrants from non-western

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countries with prior gestational diabetes mellitus

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living in Denmark. Heal Psychol Behav Med

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Rafii F, Rahimparvar SFV, Mehrdad N and Keramat A.

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Barriers to postpartum screening for type 2 diabetes:

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A qualitative study of women with previous

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gestational diabetes. Pan Afr Med J [Internet]. 2017

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Sterne V, Logan T and Palmer MA. Factors affecting

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attendance at postpartum diabetes screening in

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women with gestational diabetes mellitus. Pract

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Diabetes Int [Internet]. 2011 Mar 1 [cited 2022 Sep

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McCloskey L, Sherman ML, St. John M, Siegel H, Whyte

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Navigating a ‘Perfect Storm’ on the Path to

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Prevention of Type 2 Diabetes Mellitus After

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Gestational Diabetes: Lessons from Patient and

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Provider Narratives. Matern Child Health J

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[Internet]. 2019 [cited 2022 Aug 25];23(5).

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Pennington AVR, O’Reilly SL, Young D and Dunbar JA.

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Improving follow-up care for women with a history

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of gestational diabetes: Perspectives of GPs and

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patients. Aust J Prim Health [Internet]. 2017 [cited

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Paez KA, Eggleston EM, Griffey SJ, Farrar B, Smith J,

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Thompson J and Gillman MW. Understanding why

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some women with a history of gestational diabetes do

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not get tested for diabetes. Women’s Heal Issues

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[Internet]. 2014 [cited 2022 Sep 14];24(4). Available

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Bernstein JA, McCloskey L, Gebel CM, Iverson RE and

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Lee-Parritz A. Lost opportunities to prevent early

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onset type 2 diabetes mellitus after a pregnancy

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complicated by gestational diabetes. BMJ Open

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Diabetes Res Care [Internet]. 2016 Jun 1 [cited 2022

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https://pubmed.ncbi.nlm.nih.gov/27347422/

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Sunny SH, Malhotra R, Ang SB, Lim CSD, Tan YSA, Soh

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YMB, Ho XYC, Gostelow M, Tsang LPM, Lock

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SHS, Kwek SY, Lim YTJ, Vijakumar K and Tan NC.

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Facilitators and Barriers to Post-partum Diabetes

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Screening Among Mothers With a History of

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Gestational Diabetes Mellitus–A Qualitative Study

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From Singapore. Front Endocrinol (Lausanne)

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[Internet]. 2020 Aug 28 [cited 2022 Aug 25];11.

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https://pubmed.ncbi.nlm.nih.gov/32982985/

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Jones EJ, Hernandez TL, Edmonds JK and Ferranti EP.

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Continued Disparities in Postpartum Follow-Up and

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Screening among Women with Gestational Diabetes

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and Hypertensive Disorders of Pregnancy: A

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Systematic Review. Vol. 33, Journal of Perinatal and

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Neonatal Nursing. Lippincott Williams and Wilkins;

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p. 136–48.

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Napoli A, Sciacca L, Pintaudi B, Tumminia A, Dalfrà MG,

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Festa C, Formoso G, Fresa R, Graziano G, Lencioni

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C, Nicolucci A, Rossi MC, Succurro E, Sculli MA,

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diabetes: high-risk subgroups and areas for

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postpartum women: A systematic review of

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qualitative and quantitative studies in postpartum

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women and healthcare providers [Internet]. Vol. 22,

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Obesity Reviews. John Wiley & Sons, Ltd; 2021

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review. BMC Pregnancy Childbirth [Internet]. 2014

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from:

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Horsch A. How diet, physical activity and

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psychosocial well-being interact in women with

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gestational diabetes mellitus: An integrative review.

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articles/10.1186/s12884-019-2185-y

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Craig L, Sims R, Glasziou P and Thomas R. Women’s

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experiences of a diagnosis of gestational diabetes

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mellitus: A systematic review. Vol. 20, BMC

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Pregnancy and Childbirth. BioMed Central Ltd.;

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Dennison RA, Ward RJ, Griffin SJ and Usher-Smith JA.

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Women’s views on lifestyle changes to reduce the

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risk of developing Type 2 diabetes after gestational

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diabetes: a systematic review, qualitative synthesis

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and recommendations for practice. Diabet Med.

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Craig L, Sims R, Glasziou P and Thomas R. Women’s

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experiences of a diagnosis of gestational diabetes

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mellitus: A systematic review [Internet]. Vol. 20,

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BMC Pregnancy and Childbirth. BioMed Central

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Ltd.; 2020 [cited 2021 Nov 11]. p. 1–15. Available

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from:

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https://bmcpregnancychildbirth.biomedcentral.com/

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articles/10.1186/s12884-020-2745-1

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Buelo AK, Kirk A, Lindsay RS and Jepson RG. Exploring

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the effectiveness of physical activity interventions in

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women with previous gestational diabetes: A

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systematic review of quantitative and qualitative

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studies. Prev Med reports [Internet]. 2019 Jun 1

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Dennison RA, Ward RJ, Griffin SJ and Usher-Smith JA.

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Women’s views on lifestyle changes to reduce the

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risk of developing Type 2 diabetes after gestational

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diabetes: a systematic review, qualitative synthesis

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and recommendations for practice. Diabet Med

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Bygbjerg IC. From screening to postpartum followup - the determinants and barriers for gestational

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diabetes mellitus (GDM) services, a systematic

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review. BMC Pregnancy Childbirth [Internet]. 2014

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follow-up to the DIAMIND randomised controlled

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Horsch A. How diet, physical activity and

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psychosocial well-being interact in women with

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gestational diabetes mellitus: An integrative review.

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Morgan TL, Semenchuk BN, Ceccarelli L, Kullman SM,

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Neilson CJ, Kehler DS, Duhamel TA and Strachan

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SM. Self-Compassion, Adaptive Reactions and

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Health Behaviours Among Adults With Prediabetes

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and Type 1, Type 2 and Gestational Diabetes: A

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Scoping Review [Internet]. Vol. 44, Canadian

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Journal of Diabetes. Can J Diabetes; 2020 [cited

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https://pubmed.ncbi.nlm.nih.gov/32680775/

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Nielsen JH, Melendez-Torres GJ, Rotevatn TA, Peven K,

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Fonager K and Overgaard C. How do reminder

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systems in follow-up screening for women with

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previous gestational diabetes work? - a realist

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review. BMC Health Serv Res [Internet]. 2021 Dec

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[cited 2022 Aug 24];21(1):1–15. Available from:

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