Maternity Dietitians' Perspectives on Delivering Gestational Diabetes Care, and Postpartum Follow-Up in Ireland: A Qualitative Study

Pauline Dunne; Márcia Carvalho; Molly Byrne; Andrew W Murphy; Sharleen O'Reilly

doi:10.1016/j.jand.2023.12.012

Maternity Dietitians' Perspectives on Delivering Gestational Diabetes Care, and Postpartum Follow-Up in Ireland: A Qualitative Study

J Acad Nutr Diet. 2023 Dec 28:S2212-2672(23)01766-5. doi: 10.1016/j.jand.2023.12.012. Online ahead of print.

Authors

Pauline Dunne¹, Márcia Carvalho², Molly Byrne², Andrew W Murphy³, Sharleen O'Reilly⁴

Affiliations

¹ School of Agriculture and Food Science, University College Dublin, Belfield, Dublin, Ireland.
² Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Ireland.
³ Health Research Board Primary Care Clinical Trials Network Ireland, University of Galway, Galway, Ireland.
⁴ School of Agriculture and Food Science, University College Dublin, Belfield, Dublin, Ireland. Electronic address: sharleen.oreilly@ucd.ie.

PMID: 38158178
DOI: 10.1016/j.jand.2023.12.012

Abstract

Background: Medical nutrition therapy is recognized as the cornerstone to optimal glycemic management of gestational diabetes (GDM) during pregnancy and registered dietitian nutritionists (RDNs) are central to delivery of this, yet data are lacking on their views of the barriers and enablers to performing this role.

Objective: This qualitative study aimed to explore the perspectives of RDNs providing medical nutrition therapy to people with GDM across the Republic of Ireland.

Design: Focus groups and semistructured interviews were conducted with RDNs from maternity settings whose roles included providing dietetics services to people with GDM.

Participants and setting: Five focus groups and 2 semistructured interviews were conducted with 16 RDNs from 13 maternity sites, whose roles included medical nutrition therapy to people with GDM, in Ireland in February to March 2021. A topic guide addressing GDM management, postpartum care, and future type 2 diabetes prevention was followed.

Data analysis: Data from focus groups and interviews were analyzed using reflexive thematic analysis.

Results: RDNs collectively viewed their role as central to supporting people with GDM. Three themes were generated: Theme 1-a complex layered role-addressed complexities in dietetics practice. Theme 2 highlighted challenges in providing optimum care with sub themes of huge changes with COVID-19, care is not equal, and no defined postpartum pathway. Theme three reported on framing future health needs through sub themes of the 6-week check is a missed opportunity, people need to understand their risk, and more integrated care and type 2 diabetes prevention is needed.

Conclusions: RDNs recognize the need for continuity of care in pregnancy and postpartum for people diagnosed with GDM. However, perceived disparities in allocation of dietetics services for GDM and an absence of agreed care pathways were seen as barriers to optimum care. Collaboration and communication across primary and secondary care settings are essential and require improvement.

Keywords: Dietitians’ perspectives; Gestational diabetes; Postpartum follow-up; Qualitative research; Reflexive thematic analysis.