Why are women with gestational diabetes in Kerala at higher risk for T2DM? A qualitative study on sociocultural factors

Abstract

Aim

Gestational diabetes mellitus (GDM) is a significant risk factor for type 2 diabetes mellitus (T2DM). In India, where Kerala has a high diabetes prevalence, GDM management becomes complicated by sociocultural factors. This qualitative study aims to explore the sociocultural factors that drive the risk of T2DM in mothers with GDM in Kerala.

Methods

This qualitative study combined in-depth interviews (n = 17) with mothers with GDM (n = 6), accredited social health activist (ASHA) workers (n = 4), and healthcare professionals (n = 7), along with three focus group discussions (FGDs) involving junior public health nurses (JPHNs) (two FGDs with 12 participants each) and mothers with GDM (one FGD with eight participants each). Data were collected using semi-structured guides transcribed in Malayalam, translated into English, and thematically analyzed. Triangulation and peer debriefing ensured the validity of the results.

Results

Thematic analysis revealed four major themes. (1) Gender and power dynamics influence health prioritization; (2) cultural and traditional dietary practices, including high-calorie-rich postpartum diets; (3) knowledge gap regarding postpartum care; and (4) practical barriers and social perceptions regarding lifestyle modifications. Collectively, these factors hinder postpartum lifestyle modifications among women with GDM, thereby increasing the risk of T2DM in Kerala.

Conclusion

Postpartum health behaviors among women with GDM are largely shaped by sociocultural factors that significantly elevate the risk of T2DM. GDM should be considered an early indicator of T2DM, rather than a temporary pregnancy complication. This study highlighted the importance of sociocultural factors in effective postpartum lifestyle interventions. Addressing these challenges involves culturally sensitive, socially acceptable, community-based interventions combined with regular follow-ups with healthcare providers. Such approaches are essential to reduce the risk of T2DM and the corresponding burden on the health system and to improve long-term maternal health outcomes.