Recommendations for optimising physical activity after gestational diabetes: system targets

Gestational diabetes increases the risk of developing type 2 diabetes ten-fold postnatally, but physical activity can significantly and independently reduce this risk. Yet most interventions targeting women after gestational diabetes have not been able to change physical activity, despite seeing significant dietary changes or weight loss.

This study used a realist-inspired approach to produce theory-based recommendations, about what could work to optimise physical activity after gestational diabetes. An advisory group was initiated and guided study conceptualisation, recruitment, data collection and reviewed draft recommendations. The socio-ecological model was used to scaffold theories and create meaningful recommendations at different systems-levels. Theories were generated using systematic reviews and grey literature and were further iteratively tested and refined through qualitative data collection with a wide range of professional stakeholders and people with lived experience. Theory-based recommendations were developed and further refined through consultations with women with previous gestational diabetes, researchers, public health professionals, and Diabetes UK representatives.

Ten final theories were generated. Women need to be empowered, feel supported not just depending on family, have access to co-located and affordable childcare in physical activity spaces and be able to share experiences. The final recommendations spanned across social (n = 3), organisational (n = 6), community (n = 3) and policy (n = 6) levels of the socio-ecological model.

Fundamental patient care requirements must be fulfilled first, as without improvements in continuity of care and dedicated follow-up appointments after gestational diabetes, there is no opportunity to engage in physical activity conversations. Capitalising on existing community and local resources will also be helpful. To access activity spaces, co-located childcare is essential for some women, with further support to tailor physical activity as needed.