Diet and lifestyle services for women with a history of gestational diabetes mellitus : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand

Abstract

Background: Gestational diabetes mellitus (GDM) is a significant public health concern, affecting approximately 6.2% of pregnancies in New Zealand. Women with a history of GDM are at greater risk of developing type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), and recurrence of GDM. Evidence suggests that dietary and lifestyle interventions in the post-partum period can reduce these risks, yet there is limited understanding of what services are available to support women in New Zealand during this critical period. This study aimed to determine the availability and characteristics of the diet and lifestyle services available to women with a history of GDM in New Zealand. Methods: A cross-sectional online survey aimed at health professionals who offer diet and lifestyle services to women with a history of GDM, was disseminated through professional organisations and snowball recruitment throughout New Zealand. The survey questions were developed with the research aims and objectives in mind, informed by existing literature and researcher clinical experience. The survey was pre-tested by healthcare professionals with experience in the field and adapted accordingly prior to final distribution. Data collection occurred over four weeks across July and August 2025. The survey included both quantitative and qualitative questions, gathering data on service availability, delivery, access criteria, costs, cultural responsiveness, and barriers to care. Responses were recorded in Qualtrics and analysed in Microsoft Excel. Results: A total of 62 health professionals participated in the survey, including nurses (29%, 18/62), dietitians (21%, 13/62), general practitioners (21%, 12/62), midwives (8%, 5/62), obstetricians (5%, 3/62), nutritionists (5%, 3/62), health coaches (5%, 3/62), and exercise physiologists (2%, 1/62) from all major regions of New Zealand. Respondents largely worked in general clinical (47%, 29/62) or diabetes-specific areas (39%, 24/62). Less than half of respondents provided dietary advice (41%, 21/51), 16% (8/51) of respondents provided lifestyle advice, and 4% (2/51) of respondents offered physical activity-related advice. Other services provided by respondents included: diabetes management and monitoring (43%, 22/51), education (14%, 7/51), antenatal care (12%, 6/51), perinatal care (6%, 3/51), lactation support (4%, 2/51), and CVD risk assessment (4%, 2/51). Services were mostly accessed through self-referral (52%, 28/52) or GP referral (50%, 26/52). Ninety percent (47/52) of respondents offered in-person service delivery, with 92% of these respondents also offering alternative methods of delivery including telephone and online options. Follow-up services were offered by 94% (49/52) of respondents. Ninety-six percent of respondents reported discussing HbA1C with their patients in their service. Over a third (37%, 18/49) of respondents reported a cost for the patient to access their service, of which most (76%, 13/17) fell between NZD $5 0-100. Forty-seven percent (8/17) of respondents reporting costs to their service stated they accept community service cards which reduces cost to NZD $1 9.50. Over half (53%, 25/47) of respondents reported providing specific services for Māori, including Māori specific providers and services (56%, 14/25), and financial support or reduced costs (24%, 6/25). Just under half (43%, 20/47) of respondents reported offering specific services for other cultures, including Pacific (85%, 17/20) and South Asian (40%, 8/20) communities. Reported service gaps included lack of resources or staffing (42%, 8/19), insufficient resources for South Asian women (12%, 4/34), lack of prevention support (12%, 4/34), and limited patient education (9%, 3/34). Conclusion: This study identified variability in service provision, with fewer than half of surveyed health professionals offering dietary advice, less offering lifestyle services, and only a small proportion providing physical activity-related services. Access, cost, and cultural support vary between services and respondents describe limited resources and insufficient culturally tailored care as challenges to effectively support women with a history of GDM. These issues in service provision may leave these women at higher risk of developing chronic conditions such as T2DM and CVD, and highlight the need for more long-term, culturally responsive support for women with a history of GDM in New Zealand.