Introduction
Methods
Design
Participants
Data collection
Main interview questions | |
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1. What was the experience of having GDM like for you? | |
2. What do you think about the impact of GDM on your health in the future? | |
3. Please describe to me your current lifestyle on a typical day. | |
4. After delivery, are there any specific tradition or practices that you do or do not do in your daily life? | |
5. What are your views on a healthy lifestyle for women after delivery? | |
6. Please tell me more about your current diet on average in a day. | |
7. What are the challenges you face that make it difficult for you to improve your current diet? | |
8. Is there anything that you feel can help you improve your diet? | |
9. On average, how much time do you spend on physical activity in a week currently? | |
10. What are the challenges you face that make it difficult for you to engage in more physical activities after delivery? | |
11. Is there anything you think can help you engage in more physical activities after delivery? | |
12. What concerns do you have about your weight? |
Data analysis
Results
Participant characteristics
Characteristic | n (%) |
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Marital status | |
Married | 14 (100) |
Ethnicity | |
Chinese | 9 (64.3) |
Malay | 2 (14.3) |
Indian | 2 (14.3) |
Others (Burmese) | 1 (7.1) |
Education | |
Completed secondary school | 2 (14.3) |
Completed diploma degree | 1 (7.1) |
Completed undergraduate degree | 11 (78.6) |
Employment status prior to delivery | |
Homemaker | 2 (14.3) |
Working part time | 1 (7.1) |
Working full time | 10 (71.4) |
Self-employed | 1 (7.1) |
Housing type | |
HDB 3-4 room flat | 6 (42.9) |
HDB 5 room flat/Executive flat | 3 (21.4) |
Condominium / Landed property | 5 (35.7) |
Place of delivery for the most recent pregnancy | |
Public hospital | 7 (50.0) |
Private hospital | 7 (50.0) |
Parity | |
1 child | 7 (50.0) |
2 children | 5 (35.7) |
3 children | 2 (14.3) |
Number of GDM pregnancies | |
1 | 10 (71.4) |
2 | 3 (21.4) |
3 | 1 (7.1) |
First-degree family history of DM | |
Yes | 5 (35.7) |
No | 9 (64.3) |
Postpartum BMI, kg/m2 | |
< 18.5 | 2 (14.3) |
18.5 to 22.9 | 6 (42.9) |
≥ 23.0 | 6 (42.9) |
Identified themes
Theme 1: Risk perception and knowledge regarding future diabetes
GDM is just like, oh it was a temporary condition. So, after you give birth, it goes away. And then, kind of revert to premorbid lifestyle. (Participant 7, 27 years old, para 1)
Because I’ve cleared my OGTT, so I didn’t feel the need to do anything already. (Participant 2, 42 years old, para 3)
I think because for me, I have a family history of diabetes, so I know that you need to keep on monitoring. (Participant 9, 33 years old, para 2)
Maybe because I’m still young, so my mentality is like, I might not get it. But as I grow older, maybe. (Participant 8, 28 years old, para 2)
Post-delivery I was not given any information, I wasn’t sure whether I still need to keep to that strict diet regime that was given to me, but I didn’t bother. Because I already gave birth, so I just started eating what I wanted. (Participant 7, 27 years old, para 1)
Already done my part, I gave birth to the baby, so in terms of what I ate would not greatly affect my baby… I think there’s a bit more liberty already after you give birth… (Participant 8, 28 years old, para 2)
The moment I found out that I was GDM, I was like googling like crazy to find out how I can control my GDM and what causes GDM, you know that kind of thing. (Participant 15, 30 years old, para 1)
I just blast on my Instagram... They are just the random followers...After the lady talked to me about GI and all that, then I had a direction on what I’m supposed look for. So I started to eat low GI stuff. (Participant 13, 35 years old, para 1)
I think as a nature of human; you tend to forget things after a while. You tend to forget, oh you have GDM, GDM actually increases the risk of having diabetes. Most of the time, you will think, ok now it’s over already. I am back to normal. My OGTT result is normal now. I can slack a bit. I think we need a constant reminder that you need to be really compliant to the healthy lifestyle. (Participant 6, 29 years old, para 1)
Theme 2: Suboptimal diet and physical activity after delivery
Must eat food, confinement food, very important to bring back the nutrition into your body. (Participant 9, 33 years old, para 2)
The first two weeks, there’s a lot of herbal soups… for the womb to heal, so that it will expel out the excess blood. (Participant 15, 30 years old, para 1)
I was so hungry initially when I was breastfeeding, it killed me... I did eat more carbs after I delivered. I think it was the hunger… (Participant 3, 33 years old, para 2)
It went back right after delivery. My gynae came in and then, she saw two bags of chips by my bed. Then she said “Oh, you’re already eating this?” I told him after delivery, I want my bak chor mee (minced meat noodles), I want everything, everything that I have been avoiding… I don’t believe in limiting diet because I feel like it makes you miserable. So, I think you should eat whatever that makes you happy, as long as it’s not cancer-causing. (Participant 12, 31 years old, para 1)
I didn’t do much physical activities. Just the regular walking, you know, taking care of the baby… I do go for walks (before pregnancy). But so far in these two months, because I have to manage the baby, I haven’t had a chance to… (Participant 4, 34 years old, para 1)
To be honest, I don’t have time to really exercise, it’s just really walking… I wish I have time to go for yoga, swimming and all those, but the lifestyle now is quite tight. (Participant 11, 38 years old, para 3)
You do a lot of housework and you really sweat, especially mopping, taking things, all these are exercise. (Participant 13, 35 years old, para 1)
Theme 3: Factors influencing the postpartum lifestyle
No choice, I couldn’t really take care much of myself because I had to take care of my newborn, my son and all. So, it was quite tough… I forget that I’m hungry, I need to munch. I just lost track of time; I just keep doing things... You are physically and mentally drained and you don’t have rest. Sometimes, you have to eat faster because the child will cry for milk, or you don’t know why they are crying. You don’t even have proper time to eat. (Participant 8, 28 years old, para 2)
I feel that resting is much more important than exercise… I really don’t have enough sleep, how to think of exercise. (Participant 1, 40 years old, para 2)
There is a lot of pressure on mothers to be the perfect mother… After you deliver, you have to care for the baby, and if you don’t have help for the housework, you also have to do the housework and then cooking... You know, in the end, the last priority will be yourself. (Participant 9, 33 years old, para 2)
I know that we need to take care of ourselves, but we put ourselves second and we put the baby first. So it is difficult to get enough rest or proper food… You need to be healthy, but making those changes is a bit difficult at the moment, after delivery. (Participant 14, 30 years old, para 1)
Now I’m more conscious in eating more nutritious food. Previously, before my pregnancy, I just eat whatever I like. Now I’m more conscious, to make sure the baby grows more healthily… whatever I take, you know, it becomes the milk to feed him. (Participant 5, 34 years old, para 1)
They say you need to eat well in order to produce milk. If you don’t eat properly, the milk will get lesser. (Participant 8, 28 years old, para 2)
I think for GDM mothers, the chances of their children having diabetes will be higher. So I have to control my children’s diet. In order to control their diet, I have to control my diet also. (Participant 1, 40 years old, para 2)
It is actually really hot, it is just very warm, so I don’t bring him out, especially because he gets sweaty very easily and he gets bothered by it. (Participant 7, 27 years old, para 1)
My mother in law doesn’t allow me… I was doing some yoga stretches, then she was like, what are you doing?! She said I cannot engage in all these activities for the first month, the womb will come down, this kind of thing… (Participant 9, 33 years old, para 2)
You definitely need some support from your family. You need somebody that really can sync the same thought with you, so that you can continue with your healthy lifestyle. (Participant 6, 29 years old, para 1)
My husband is not the person who likes to have this kind of healthy lifestyle. So it’s quite difficult for me because he’s a very fussy eater, he doesn’t eat certain foods… if I cook for myself, and then cook for him, it’s quite tough... (Participant 8, 28 years old, para 2)
I think it is the wealth of things we have. We have an abundance of choices. Everywhere you go, the temptation, the abundance of cakes, fruits, chocolates. So that is the challenge. (Participant 4, 34 years old, para 1)
It can be quite expensive though, eating healthy in Singapore. You want people to cut down on all that diabetes, but your healthy options are not cheap. If you want to eat a salad bowl, it is probably 6, 7 dollars. And then you can get a McDonald meal for cheaper. (Participant 14, 30 years old, para 1)
I think exercise is good for you anyway. And for me, I had a very big belly by the time I delivered… So, me wanting to go back to exercise is for me, not because of GDM per se… (Participant 3, 33 years old, para 2)
To look good, to feel confident, so that I can have that mood to go out. I feel like all the clothes don’t fit me, I don’t know, I feel a bit upset. (Participant 7, 27 years old, para 1)
Overall, not just weight management, I think diet management and exercise all come together. If not, the risk is getting into a type 2 diabetes. (Participant 2, 42 years old, para 3)
After you delivered your baby, I guess most mummies don’t have much time for physical activity for the first few months. So, I think diet does play a very important role. (Participant 6, 29 years old, para 1)
I see them (husband and children) lazing at home, then I’m like, why should I go run, ok I’ll wait for you when you all are ready to go… To even get changed to get out to run is a discipline on its own! I think it’s personal, the hurdle is personal… (Participant 2, 42 years old, para 3)