British-Pakistani women with Gestational Diabetes: Understanding the antenatal and postnatal factors contributing to their future risk of developing Type 2 Diabetes

Background Gestational Diabetes (GDM) is a type of diabetes that develops during pregnancy, when women have high levels of sugar in their blood. One in 20 pregnant women in the UK are diagnosed with GDM.

GDM usually goes away after the pregnancy ends, but around half of the women with GDM develop another form of diabetes, Type 2 Diabetes (T2DM) within five years of their pregnancy.

The chance of developing T2DM is increased if women have an unhealthy diet, don’t get enough exercise or control their blood sugar levels as advised by a healthcare professional.

South Asian women, meaning women from Indian, Pakistani, Bangladeshi, and SriLankan ethnicities, are at a much higher risk of developing GDM and developing T2DM afterwards, compared to other ethnic groups in the UK.

To fix this, we need to understand the experience of South Asian women with GDM and provide care that meets their needs. However, people from different South Asian backgrounds should not be treated as one group.

There are differences in culture, religion, education, language, lifestyle, and views about health which can impact their experience in dealing with GDM and their risk of developing T2DM afterwards.

Previous research has grouped all South Asian ethnic groups together, so we do not understand the different experiences of each group.

In particular, British-Pakistani women (BPW) have higher rates of GDM compared to other South Asian groups and are also more likely to develop T2DM compared to White British women. BPW are also a large population in the UK who experience poorer health than many other ethnic groups.

It is therefore important to understand why many BPW are developing T2DM after GDM and how their healthcare can be improved to prevent this.

Aim To explore the health experiences of BPW with GDM during and after their pregnancy, including how they engage with recommended healthcare services to understand why they may be at a higher risk of developing T2DM, and how this could be reduced. Methods I will carry out three studies: 1. I will survey BPW with GDM to find out what they know about GDM, how it should be managed and possible outcomes.

I will find out what they know about, and if they plan to attend two services the NHS offers to women with GDM after birth.

This includes blood sugar testing and the Diabetes Prevention Programme, which provides support on following a healthy lifestyle to prevent T2DM. 2.

I will identify how many BPW with GDM get referred to, start and complete the Diabetes Prevention Programme after pregnancy compared to other ethnic groups. 3.

I will interview BPW who have experienced GDM to understand which factors impact their GDM experience, healthcare and how they follow recommendations. I will interview health care professionals such as GPs and midwives to understand their views on this too. 4.

I will hold workshops with BPW and healthcare professionals where we will review the results of the research and work together to create recommendations for how GDM healthcare can be improved for BPW.

PPI BPW with lived experience of GDM will be involved throughout each study, making sure it addresses their needs and concerns.

This will include reviewing study materials, checking they are sensitive and relatable to BPW, guiding how we interpret the findings and sharing findings with the community.

Dissemination My findings will be shared with the general public, BPW and healthcare professionals across the UK using published articles, video summaries, posters and talks.

I will share the GDM healthcare recommendations for BPW with local governments and policymakers involved in maternal healthcare to promote positive change in GDM care for BPW.