Views of women and health care providers regarding type 2 diabetes screening and preventive strategies post gestational diabetes: an interview study

Background: Gestational diabetes mellitus (GDM) significantly increases the risk of developing type 2 diabetes (T2DM) and cardiovascular disease, particularly within the first decade after childbirth. Despite recommendations for healthy lifestyle behavior and regular glycemic monitoring, adherence is low due to unique challenges during the postpartum years. Furthermore, the acceptability of pharmacotherapy of T2DM prevention remains unclear. Study Design: Semi-structured in-depth interviews of women with GDM-affected pregnancy within the preceding 5 years and health care providers involved in GDM care. Topics included perceptions of T2DM risk, views on preventive pharmacotherapy, and barriers and facilitators to screening and prevention. An inductive and deductive approach was used, and the barriers and enablers summarized using the Capability Opportunity Motivation-Behavior model. Results: We conducted semi-structured, in-depth interviews with 24 women and eight health care providers. Key influences on engagement in prevention included knowledge, attitudes, and personal circumstances (capability); self-perceived heightened risk, belief in the efficacy of behavior change, structured routine, and accountability (motivation); and access to support and guidance (opportunity). While lifestyle interventions were preferred, pharmacotherapy was considered acceptable by some—particularly health care providers and women who perceived higher risk or faced barriers to lifestyle changes. Conclusion: The study highlights ongoing concerns about the lack of progress in improving care for this population. Importantly, it provides novel evidence that health care providers and some women, particularly those facing barriers to lifestyle modification, support exploration of pharmacotherapy as a strategy to prevent T2DM in those with histories of GDM.