“To be honest, no one cares”: an ethnographic study of postpartum perceptions and practices after gestational diabetes in Vietnam

Abstract

Background

Gestational diabetes mellitus (GDM) may adversely affect the long-term health of mother and child, as the condition puts both at risk for developing type 2 diabetes (T2D). Maintaining healthy behaviors/habits and undergoing a postpartum oral glucose tolerance test (OGTT) are validated strategies to prevent T2D as well as other long-term health issues among women with previous GDM. There is a need for more knowledge about how women with previous GDM perceive their health risks and practice self-care in the postpartum period, particularly in low- and middle-income settings.

Objectives

This ethnographic study investigates how women with GDM in Vietnam perceive their diagnosis and practice self-care in the postpartum period, focusing on examining the interplay between postpartum maternal responsibilities, family support, and healthcare system engagement.

Methods

In-depth ethnographic interviews were carried out with 20 mothers who were three to six months postpartum after experiencing GDM in their most recent pregnancy. The interviews were held in the participants’ homes, using a phenomenological approach to explore their experiences and analyze the data.

Results

Three themes emerged from the analysis as particularly pertinent to women’s self-care after GDM: (1) Lack of routine postnatal care and T2D screening in the healthcare system; (2) The mother’s attention and priorities in the postpartum period; (3) and Family expectations and cultural norms shape women’s postpartum health behaviors. The mothers and their family members showed a low-risk perception of GDM’s long-term risks, influenced by traditional customs and insufficient information from the healthcare system. As a result, many women viewed their T2D screening postpartum as insignificant. Prioritizing their own health and practicing postpartum GDM self-care were highlighted as challenging, as the child’s development became the whole family’s primary concern.

Conclusions

This study provides insights into mothers’ postpartum experiences following pregnancies with GDM, highlighting the barriers to GDM-compliant postpartum self-care. Addressing GDM self-care information gaps within the health care system, coordinating health care follow-ups for mother and child, and engaging family members in communication programs can support women in continuous postpartum care practices.

Trial registration

NCT05744856. (Registration Date: 2023-02-15 and Last Update Posted: 2024-04-30)

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-025-08399-x.

Background

Gestational diabetes mellitus (GDM) is a significant health problem that has attracted the attention of health professionals and researchers worldwide [1]. GDM occurs during pregnancy as a hyperglycemic state and usually disappears after birth, but the condition increases the risk of developing type 2 diabetes (T2D) in the future for both mother and child [2]. For the mother, the risk of developing T2D is increased nearly tenfold and is exceptionally high in the first five years following pregnancy [3]. Due to this significant risk, postpartum screening and the continuous practice of GDM-compliant self-care after childbirth are recommended [4–8]. Most recommendations suggest that T2D screening should be conducted within the 12th week postpartum with an oral glucose tolerance test (OGTT) [4, 7]. Early screening identifies new mothers at high risk for T2D and provides an opportunity for counseling, supporting the reduction of the risk of developing T2D. Despite these recommendations, the rate of T2D screening within the first three months postpartum is often below expectations, ranging from less than 10% to under 50% globally [9–12]. It has led to a focus in research on highlighting the importance of testing in the postpartum period, how testing is underutilized, and calls for developing effective strategies for motivating new mothers to get tested in the postpartum period [13–16]. The common potential risk factors that hinder postpartum screening and blood glucose self-management include a lack of awareness of GDM long-term risks, unclear or no recommendation on performing OGTT-testing postpartum, and the time requirements and inconvenience of getting tested [17, 18]. However, most of these studies have been conducted in high-income countries, leading to a lack of knowledge on barriers and facilitators for postpartum testing in low-income countries. This gap results in a shortage of research on culturally tailored interventions and strategies for postpartum diabetes management [19].

Vietnam is facing a high prevalence of T2D and GDM among its citizens, coinciding with its rapid economic growth and development [20]. The increasing focus on GDM in clinical practice and research drives the rapid development of recommendations and guidelines globally and in Vietnam. In the latest national guideline for the prevention and management of gestational diabetes mellitus (GDM) published by Vietnam’s Ministry of Health in 2024, it is recommended that mothers with previous GDM undergo an oral glucose tolerance test 4 to 12 weeks postpartum. If the results are normal, they should get fasting plasma glucose screening every 1 to 3 years thereafter [21]. However, there are no specific guidelines regarding counseling and follow-up services on dietary modification, physical activities, or weight management in the postpartum period, especially in the local healthcare system [21]. Previous findings from this study showed that pregnant women with GDM in Vietnam struggle as “pioneers” in managing their condition, as this is a new health problem in Vietnam, and their family and community members do not always recognize their challenges [22]. The women faced several challenges that hindered their ability to engage in self-care, particularly in managing blood glucose levels and undergoing OGTT screening as recommended [17]. While it is a fast-developing field, it has been pointed out that the care for women with GDM in the postpartum period is often overlooked [23, 24]. However, the postpartum period is a vulnerable state where women are adjusting to motherhood and where data suggest a link between GDM and postpartum depression [25]. Additionally, results from other contexts suggest that some practices culturally believed to be healthy in the postpartum period may negatively influence the GDM self-management of new mothers [26].

To date, there has been no ethnographic study in Vietnam focusing on the potential social and cultural factors that influence women’s self-care behaviors in the postpartum period. Therefore, this in-depth ethnographic study aimed to explore these underlying factors affecting the perceptions, attitudes, and postpartum self-care behaviors among new mothers with previous GDM. Our findings highlight the importance of bridging the information gap in GDM self-care postpartum within the national healthcare system, coordinating routine healthcare follow-ups for mother and child, and engaging family members in communication programs, which can support women in continuous postpartum care practices.

Methods

Study setting

The ethnographic research was conducted in Thái Bình province in northern Vietnam’s Red River Delta area from April to May 2023. Thái Bình province is known as the wet-rice granary of North Vietnam. It is a developing industrial area with around two million inhabitants. Along with fast-developing socio-economic conditions, Thái Bình is facing a rising prevalence of chronic diseases, including diabetes, across all population groups. In a study from 2023, the prevalence of GDM in Thái Bình was found to be 20.2% [27]. Meanwhile, this number reached 27.1% in our findings in stage 1 of the present project [28].

Although GDM can lead to various unacknowledged health outcomes for mothers and infants, GDM testing was only introduced in private clinics in Thái Bình in 2018 and in provincial-level hospitals in 2019. When a woman tests positive for GDM, counseling and support are very limited, and many women rely on Internet sources for information about how to handle their GDM [22, 29]. In 2024, Vietnam’s Ministry of Health issued a new guideline that includes GDM testing as part of the routine antenatal care process; however, it is still not covered by health insurance [21].

Study design and sample

This ethnographic study investigates new mothers’ perceptions and experiences of post-GDM self-care and screening as part of an ongoing interdisciplinary Vietnamese-Danish research project exploring self-care practices among pregnant women with GDM, the VALID II study [30]. A total of 21 cases were recruited from a larger sample of 233 pregnant women diagnosed with GDM in phase 1 of the project [28]. For the initial contact, we made 105 phone calls to invite all women diagnosed with GDM by that time, from January to April 2023, to participate in the ethnographic study. We received consents from 21 women, while others refused due to their full-time work schedule or doubts about becoming targets of scammers or maternity product marketing. Almost all participants (20/21 cases) agreed to participate in the study’s postpartum part, which included in-depth interviews in their homes (Supplementary file 1. Open-ended interview guide) [22].

This ethnographic study examines the women’s experiences during the postpartum period, specifically between three to six months after childbirth. Grounded in phenomenological anthropology, we conducted extended case studies that situate individual postpartum experiences of GDM within broader social, cultural, and healthcare contexts. Ethnography is particularly well-suited for gaining a holistic understanding of these experiences, as it goes beyond qualitative interviews by including contextual observations such as moods, settings, and social relations [31]. The phenomenological approach further enriches the study by emphasizing the lived experiences of the women, offering an empathetic lens through which to understand their postpartum challenges with GDM [32]. In our foregoing study focusing on the pregnancy period, this method gave us rich material suitable for a rigorous analysis [29]. This paper adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines utilized for reporting qualitative studies [33].

Data collection process

We conducted in-depth ethnographic interviews with new mothers three to six months postpartum in their homes. The home visit lasted around two hours, each conducted by two authors. Participants had the option to be interviewed alone or to invite family members to participate. An open-ended interview guide (Supplementary file 1), developed collaboratively by all authors, was utilized in all interviews, not only facilitating an approach to the key themes but also creating an open space for conversations. All women had previously been interviewed by the same researcher during pregnancy, which meant that the women had become familiar with the researcher at this point. Thus, the new mothers and their families appeared comfortable and willing to converse and share their feelings and experiences. The prolonged time spent between the women and researchers built rapport and thus ensured the trustworthiness of the data collected [34]. Additionally, most researchers knew local customs and languages, allowing us to understand local terminology and avoid making personal judgments about their daily habits.

Detailed field notes were taken during each interview, incorporating the participants’ words, reactions, and body language, and accompanied by photographs taken by the researchers during the visit. All the conversations were voice-recorded under the participant’s permission, transcribed verbatim by a transcription team. To ensure the transcripts’ accuracy, the interviewers verified these complete transcripts by cross-checking them with the original audio. Any errors or unclear segments were re-listened to and edited.

Data analysis

The data were systematically coded using a topical coding list that was discussed, agreed upon, and standardized within the co-authors’ team. The researchers coded the following topics:

• Health, including child’s health (A1), breastfeeding (A2), postpartum health (A3), postpartum self-care (A4), and using social media for health information (A5).

• The Family System, including the health, life, and childbirth of the grandmother (B1), societal changes (B2), and sharing experiences of GDM across generations (B3).

• Postnatal Family Life, including family care for the child (C1), family care for the mother (C2), and changes in family members with a new addition (C3).

• Gestational Diabetes Mellitus, including current thoughts on GDM, self-care activities, and plans for GDM testing (D1).

Throughout the coding process, the authors frequently communicated to resolve, adjust, and agree on the coding (if necessary) with consensus among the members. Subsequently, the data was uploaded and stored on a safe online drive to ensure the safety and confidentiality of the information.

Following the coding, the authors conducted a phenomenological analysis of the coded material, which led to the identification of the three overarching themes presented in the results section. This analytical approach involves bracketing the researchers’ own preconceptions and biases in order to understand the women’s lived experiences as they are experienced, without assuming or imposing taken-for-granted notions. Phenomenological analysis requires ongoing reformulation of insights, a process the researchers engaged in collaboratively throughout the process of analysis and writing [35, 36].

Ethical approval

This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and granted ethical approval by the Ethics Committee of Thai Binh University of Medicine and Pharmacy under decision number 1209/HĐĐĐ dated 1 December 2022. The study was registered at ClinicalTrials.gov (NCT05744856). Participants were informed about the study’s objectives, procedures, and their right to withdraw at any time. They provided fully informed, voluntary consent by signing a written consent form. All data are used exclusively for research purposes and are accessible only to the research team.

Results

Characteristics of participants

All 20 women were married, with 16 living with their husbands. For the remaining four cases, the husband worked away from home and only returned for weekends and/or vacations. Twelve women lived in multigenerational households; eight lived in nuclear families. Including the recent delivery, eight women had one child, while three had two children, seven had three children, one had four, and one had five. The women had a mean age of 30.1 years and were employed in various occupations, such as factory workers, teachers, office workers, and health workers (Table 1).

Table 1.

Overview of characteristics of participants

Characteristics		Frequency (N = 20)	Percentage (%)
Age	Mean (range)	30.1 (20–47)
Occupation	Factory worker	7	35.0
	Teacher/office worker/health staff	9	45.0
	Freelance business	4	20.0
Marital status	Living with husband	16	80.0
	Not living with husband	4	20.0
Household	Two-generational	8	40.0
	Three-generational	10	50.0
	Four-generational	2	10.0
Number of living children	1	8	40.0
	2	3	15.0
	3	7	35.0
	4	1	5.0
	5	1	5.0

Our findings reveal that women with GDM face new challenges in the postpartum period, transforming GDM, which may have been a concern during pregnancy, into something that disappears from their daily lives. As new mothers focus on their child’s health and as attention from relatives and healthcare professionals also shifts towards the child, many mothers in our study appeared to deprioritize or disregard their GDM diagnosis. We identified three key themes that can help to explain how GDM becomes less prominent in the daily lives of women during the postpartum period:

• Theme 1: Lack of routine postnatal care and T2D screening in the healthcare system.

• Theme 2: The mother’s attention and priorities in the postpartum period.

• Theme 3: Family expectations and cultural norms shape women’s postpartum health behaviors.

We will explore these in the following sections.

Lack of routine postnatal care and T2D screening in the healthcare system: “I did not think I had it; I thought I was cured.”

Similar to during pregnancy, women with GDM in the postpartum period received very limited counseling and support from health care providers. Out of concern for their child-to-be’s health and growth, most women actively searched for information while they were pregnant [22]. In the postpartum period, however, most of the mothers stated that they did not receive any information on the likelihood of developing T2D in the future for both mother and child or advice on postnatal testing and management from the healthcare system. At the time when we met them in the postpartum period, none of the women had gone for postpartum testing or check-ups yet.

One mother, Ha, explained how the lack of counseling caused her to worry and doubt how to manage the condition postpartum: “I was also worried; I was afraid that when I get older, I might get it too, just thinking about it. And as for my little boy, I did not know if he might also get it.” She continued: “If I have GDM and it affects my child, of course, I would care. Many people would also want to know. For example, if no one told me, I would not think about it. But, if someone mentions it, then maybe I’d start looking into it.”

Hương, like many other women in this study, shared that she had never heard about the postpartum blood sugar test from healthcare providers: “No, I did not know about that [OGTT postpartum],” Hương said in a surprised tone, “Do I have to do it again at 12 weeks postpartum? Twelve weeks is three months, right?… Mine has already been four and a half months….”

Even Học, a health care worker, did not know about postpartum OGTT testing: “I thought that the test was just a blood test [fast blood glucose]. I’m not sure if it’s necessary to do the OGTT or not.”

Some mothers did not consider GDM a concern at this point. Most of them pointed out that because their OGTT results at 24–28 gestational weeks were just slightly higher than the standard, they believed that their child and they would not be at risk after giving birth.

An shared: “I did not think I had it; I thought I was cured,” and Huong shared: “I do [care], but I no longer find it important.” Thơm, who works as a doctor, said: “I don’t even think about getting tested anymore.” Toan, a 20-year-old mother who thought of herself as being at the age of eating and playing, said: “I don’t care. I don’t think about it [GDM], so I don’t think about those things [GDM risks] either.”

With limited postnatal care information from the professional healthcare system, few women sought out information about the risk of the condition to themselves and their child online through Google, YouTube, Facebook, and TikTok or from friends in the neighborhood. “I had already searched [online] that I had to do the test again, but then it was all messed up, and I forgot,” 32-year-old Yen shared. Like Yen, Trung (29 years old) had also sought information online: “I researched and knew that after two months, I would need to go for a follow-up check. But I haven’t gone yet. After giving birth, I was busy taking care of my baby and my mom, so I didn’t think about going anymore. I haven’t had time, and there’s no one to help take care of things, so I can go. Time just slipped by, and now it’s been four months, and I still haven’t gone [laughs].”

In a few cases, the women were informed by their doctor to get a follow-up. Thao, a 23-year-old mother, said: “For me, the day I gave birth, the doctor said that from 6–12 weeks, I needed to go to check again.” After five months postpartum, she still had not planned a time to do it.

Thus, in cases where the mothers were aware of the recommendation to get an OGTT test postpartum, they still did not get it. To most, arranging the time for OGTT testing was the biggest obstacle, often because the mothers had to travel to the city to get the test. Hương shared that because of the inconvenience of getting from the village to the city, she could not get tested before she returned to work: “Oh my god, if it was (OGTT), I had to wait to come to work. Because now, if (I) wanted to do that, I had to go to the city… There was no place (to test) in my area; it could take half a day.”

Further, as Trung explained, the mothers had many responsibilities with their new child, which would make it difficult to take time to go to the doctor. It was also the experience of Uyên, who had just given birth to her fifth child at 47 years old and also helped to care for her newborn granddaughter: “I haven’t done it [OGTT] yet… I haven’t had time to go to the hospital yet… No, I haven’t had time since I gave birth; I’ve been very busy.” Uyên explained further: “I was afraid that if I went too long, my child would cry, so I hadn’t dared to go [take the OGTT].” Thus, the mother’s obligation to the children was prioritized over following up on her GDM condition.

Without adequate knowledge about the continued risk of GDM postpartum, women did not know how to manage their condition in the period after giving birth, which in some cases meant that they started to disregard it entirely, with some considering themselves cured, even when the condition had caused them to worry during pregnancy. In the cases where women were aware of the need to get tested postpartum, their obligations as mothers created significant barriers to getting tested.

The mother’s attention and priorities in the postpartum period: “I even had to eat more to have milk for my baby.”

In July 2023, Trịnh had just given birth to her second child, one day before the set due date, without any complications. At this time, Trịnh was 28 years old and lived in a small village in a rural area 30 min away from the central city by car. Trịnh’s husband was in the army and stationed far away from the village. During our visit, Trịnh was alone in the house with the baby girl while her mother-in-law was at work and her son was in school. While Trịnh had breastfed actively from the beginning, she now had problems with the milk flow and was supplementing with formula. Since Trịnh had GDM during both her pregnancies, and because her HbA1c result was at an average level of 6.1%, Trịnh was no longer worried about the condition and was not concerned about getting diabetes in the future, as the child was born healthy. Trịnh no longer maintained the same eating and exercise habits as when she was pregnant. “I even had to eat more to have enough milk for my baby, both the number of meals and food,” she told us.

Like Trịnh, the priority of most mothers in our study was the growth and development of their child. To ensure their babies grew, the women actively consumed more foods and supplemented with items believed to increase their milk supply. “On days when I had little milk, besides three main meals, I ate porridge or drank milk around 3 pm or 9 pm,” Trịnh told us. The attention to their child’s growth and development was thus perceived to be connected to their own eating habits, leading them to leave behind the diabetes/GDM-friendly eating habits they had followed during pregnancy [29].

When a child had a weight or height above the standard, the mothers shared it with us with joy and pride: “I saw the standard for this age is 58 cm, but my baby was already 61 cm. When I took my baby for vaccinations, the doctors said she’s taller than other babies and could become a beauty queen someday.”

Son, a 35-year-old mother with three kids, said, “Actually, at that time, even though I had it [high blood glucose], I would not dare abstain because it related to the baby’s diet… I did not think about it anymore and just ate.” Son explained that she was willing to sacrifice her own diabetes self-care routines for the sake of her child: “[I am] still sacrificing myself to breastfeed and provide milk for the baby.”

Aside from their growth, the women were highly concerned with their child’s sleep. Khanh, a 20-year-old mother who had experienced low moods during pregnancy, was happy that she produced enough milk and that her child slept through the night. Babies that did not sleep well were described as ‘fussy (quấy)’ or ‘difficult (khó tính),’ as this meant that the mother usually had no time to rest because they would have to stay awake to soothe the child. An, a 41-year-old mother of three, shared that she hardly slept, which made her feel exhausted: “My skin was pale and gray, unlike a woman who had just given birth.” The women’s attention was thus drawn to their chidren’s growth, which they saw as connected to their eating habits and to their children’s sleep, which was crucial to the women’s own rest and overall well-being.

In addition, taking care of other family members and doing housework were also priorities for the mothers. Most (12/20) of the mothers in our study had two or more children who would also need their care. In Vietnam, the husband has the right to 5–14 days of leave after his wife gives birth, depending on the type of delivery and number of children [37]. If the couple’s parents could not support them or they could not afford to hire domestic help, the new mothers were solely responsible for the household chores while caring for the newborn and other potential children. This could result in stressful situations for the women, as experienced by Trịnh: “My eldest son got sick, and this baby refused to be fed from the bottle. As for my husband being away from home, I had already prepared myself for that […] Even now, I am doing everything on my own (một mình cáng đáng).”

For the mothers, the postpartum period could be a busy and stressful time, which would not allow them to focus on their self-care. For example, most mothers stopped exercising – one of the components of GDM management – after giving birth. Ly, a 25-year-old mother, shared: “After giving birth, taking care of the baby was tiring, and I couldn’t exercise at all.”

Being focused on the care of the child while trying to take care of themselves postpartum proved to be a difficult task, both physically and emotionally. Although they had just experienced the pain from delivery, most had to overcome their physical exhaustion and practical challenges due to the child’s immediate needs, such as feeding, diaper changes, and soothing. The mothers’ heightened attention toward their newborn child, their other children, and taking care of the household in general meant that GDM fell into the background during the postpartum period.

Family expectations and cultural norms shape women’s postpartum health behaviors: “Diabetes is Diabetes. Just eat.”

While the women found it difficult to maintain their previous GDM-compliant habits in the postpartum period, they were simultaneously encouraged by family members to abandon these habits for the sake of the child. As shown in our previous article focusing on the pregnancy period, many relatives did not worry about the GDM diagnosis and sometimes even dismissed it entirely [22]. In the postpartum period, the women still experienced that family members would disregard the GDM and that they were highly concerned about the child’s growth. For example, Trịnh’s husband was happier and more comfortable, as Trịnh had stopped her GDM-compliant eating habits and started eating more: “He reminded me that the first baby was skinny because I ate less […] [he] even told me to eat more [for this second baby].” Trịnh experienced that her family’s concerns were now exclusively focused on the health and development of the newborn child: “They even advise to eat more, they say leave it alone, my sister-in-law also said just to eat so that the baby is healthy.” Trịnh noted that no one in her family cared or reminded her about GDM after giving birth: “No, no one mentioned it anymore.”

If the child’s growth was below standard or did not look as chubby as other babies, the new mother would receive negative comments or be reprimanded (quở) by relatives and friends. Học, a 39-year-old nurse, had not received the support she had sought from her husband during her pregnancy. In the postpartum period, this had not changed: “To be honest, no one cares.” She said in a sad tone: “He was indifferent […] it was like he was in a different career from me, so he also saw it as normal.” As her child was not as chubby as others, Học received negative comments on her child’s weight: “Everyone said it was skinny; it was like [I] got worried. Their children were like this, but mine was like that.” The mother-in-law of Thao, who had twins with an average weight of 2.6 kg to 3.3 kg within three months after birth, perceived this weight gain as slow and consistently wished for her grandchildren to gain more weight. She expressed her concern, saying, “A bit slow, especially the younger one… Yes, I want my grandchild to gain a little more weight.”

In the postpartum period, the husbands and other relatives generally believed the women had fully recovered and paid no attention to the condition at all. Hương said about her experiences in the postpartum period: “Everyone is probably mainly focusing on how to have more milk for the child. The issue of GDM or no GDM was not so important because my blood test was not too high.” It was the experience of most of the women in this study. Ha, a mother of three, shared: “Everyone [her family members] thinks I do not have it anymore.” 32-year-old Thơm received the following advice from her parents-in-law, which echoes the perception of many of the women’s relatives: “Diabetes is diabetes; just eat.”

Only four of the women had relatives who were still concerned with the GDM condition postpartum. Two mothers, Uyên, who had to inject insulin during her pregnancy, and Ga shared that their husbands reminded them to go for a GDM check-up after giving birth. “Oh, my husband is diligent in urging me about my health, very worried,” Ga explained. Khanh also mentioned that her sister-in-law, a health worker, often reminded her to go for a blood sugar check-up after giving birth, and Trung was reminded by her younger sister, a pharmacist, to get check-ups. Still, none of them had gone yet.

Women were mainly encouraged by their families to prioritize their attention towards caring for the newborn, other children, and the household, and to forget about GDM altogether. When the health system did not inform or remind them about the continued risk of GDM, the women were mainly discouraged from following up on their condition. Even when the women had a family member who reminded them about doing the check-up, this did not motivate the new mothers enough. In the postpartum period, characterized by new overwhelming obligations towards the child, the GDM diagnosis, which had worried them during pregnancy, faded and ultimately disappeared from their focus.

Discussion

Although the risk of developing T2D in the future following a pregnancy with GDM for both mother and child is well established [3], and attention to GDM, in general, is growing, there is still much room for improvement in GDM management in the postpartum period. Most mothers and their families in our study assumed that GDM is a temporary condition and that the mother’s health returns to normal after giving birth, consistent with findings in previous studies [26, 38, 39]. This misconception could lead to the neglect of T2D screening and the discontinuation of healthy behaviors among postpartum women. Although studies from various contexts have found that the rate of T2D screening within the first three months postpartum is below expectations [9–12, 16], it is noteworthy that none of the women in our study underwent postpartum testing. This finding underlines a missed opportunity for continuous management and early prevention of T2D. While most women managed their blood sugar levels through diet modifications and increased physical activity during their pregnancy, our results showed that most mothers discontinued these healthy self-care practices postpartum. This finding aligns with previous studies from other contexts showing how healthy habits like diets and sufficient physical activity are difficult to maintain for women after birth [40–43].

Lack of routine postnatal care and T2D screening in the healthcare system

One of the key factors leading to women’s disregard of GDM postpartum is non-specific postnatal care and the absence of a routine postpartum T2D screening reminder system in Vietnam’s national maternal care framework [21]. It was similar to the pregnancy period, when most pregnant women were pioneers in seeking information from various sources on the Internet to self-manage their GDM condition [22, 44]. Our results showed that the mothers received limited or no professional advice or guidelines on the continuous management of GDM and appropriate postnatal care. However, contrary to the pregnancy period, the women in the postpartum period did not seek out information online. Only a few women continued to seek information on GDM postnatal care, but not to the same degree, as their daily tasks as new mothers took up most of their time. This gap in information about the postpartum period not only existed in Vietnam but is reported in studies from various contexts [17, 26, 38, 45–47]. A systematic review [48] highlighted that most recommendations globally in current clinical practice guidelines are not based on high-certainty evidence, and frequently, these guidelines are insufficiently addressing the unique needs of postpartum women with previous GDM, particularly regarding mental health, a significant element of postpartum well-being [49, 50].

A qualitative study in Ireland highlighted health professionals’ information as facilitators for women who want to get the OGTT test [51], and multiple studies have highlighted the importance of reminder systems for postpartum testing and better coordination of postnatal care in healthcare systems [14, 52, 53]. One RCT conducted in Denmark shows that electronic reminders effectively enhance follow-up screening in the intervention group (RR: 1.20; 95% CI 1.03–1.39) [54]. Additionally, a study from Singapore showed that bundling scheduled appointments was a facilitator for postpartum screening [15].

The mother’s attention and priorities in the postpartum period

Another major factor that can influence women’s perceptions and practices in the postpartum period is the attention paid to the child’s current health and growth, leaving the mother’s health overlooked. As kinship is patrilineal and patrilocal in Vietnamese, a woman’s reproductive success secures her position within her husband’s family. The pregnancy period is thus a period of high stakes for women, where the woman might be blamed if the child is not born healthy or grows in an unsatisfactory manner after birth. In the Vietnamese context, a successful birth is sometimes declared through the proverb: “The mother is round, the child is square” (mẹ tròn con vuông). This refers to a cosmological connotation of childbearing where ‘round’ refers to heaven and ‘square’ refers to earth, thus signifying a harmonious relation between humanity and higher powers [55], and describes the woman’s success in adhering to social norms associated with healthy birth and infant care. Therefore, after undergoing significant stress during pregnancy, the women diagnosed with GDM felt great relief when having a successful birth.

Additionally, the child’s healthy development after birth quickly filled their focus, deprioritizing their own health. Many women in our study reported struggling to find time to take care of themselves and manage their postpartum health due to childcare demands and household responsibilities, with a lack of support and encouragement from family members. This resonates with our findings in previous research on everyday diabetes management: “Within households, social obligations press on daily lives, often making it impossible to practice ‘self-care’ according to biomedical standards [56].” Studies from other contexts similarly highlight the difficulties women with previous GDM experience in balancing the role of motherhood, the demands of a newborn, and caring for one’s own health [57–59]. Indeed, several studies have shown that women who can maintain a healthy lifestyle during pregnancy with GDM and postpartum are strongly motivated by the support of their husbands and other family members [17, 58, 60–63]. One study from China showed that the support of the husband and mother-in-law in the postpartum period significantly impacts new mothers’ emotional and mental health [64], further emphasizing the role of relatives in the postpartum period.

Family expectations and cultural norms shape women’s postpartum health behaviors

Customary practices play an essential role in shaping postpartum behavior changes, particularly in contexts where traditional beliefs about a healthy postpartum period can sometimes conflict with medical recommendations for the postpartum period following a pregnancy with GDM. According to Vietnamese conceptions, a healthy child is chubby and chunky, with a roly-poly belly and thighs [65], leading most women in our study to consume substantial amounts of food to ensure a sufficient milk supply for their babies to grow. If the child’s growth did not meet these expectations, the mother would experience guilt. To comply with these social norms and to become successful mothers, the women were willing to sacrifice their newly attained healthy habits and self-care practices. This aligns with Shohet’s study on the role of family sacrifice in Vietnam, where sacrifice is seen not as a suffering act but as a necessary and willingly performed act of devoted care that subordinates personal desire [66].

Furthermore, as in some other Asian contexts, like China [26, 67] and Singapore [38], Vietnamese women are socially encouraged to follow a confinement period after birth known as “doing-the-month” or “sitting month.” The confinement requires women to rest at home as much as possible, avoid physical activities like climbing stairs or walking, and actively nourish themselves with food to ensure optimal recovery for the mother, as well as an abundant milk supply for the child in the first months after birth [68]. This combination of traditional views, social norms, and the perception of GDM no longer being a risk factor could have a significant influence on why new mothers stop practicing good health behaviors for themselves, which starkly contrasts with recommendations from the postpartum lifestyle intervention studies on T2D progress prevention [69–71].

Strengths and limitations

To our knowledge, this is the first ethnographic study to examine the perceptions, responses, and experiences of mothers with prior GDM during the postpartum period in Vietnam. This research is significant because it highlights the challenges mothers face in balancing the sociocultural demands of motherhood while adhering to the healthy behaviors/habits they acquired during pregnancy. One of the key strengths in our study is the close rapport established between researchers and participants, which was created through multiple interviews conducted from pregnancy to postpartum. With an iterative and flexible approach, we gained valuable insights and a deeper understanding of how mothers perceive GDM and how it seems to matter less after birth. Nevertheless, this approach requires a relatively small sample size.Our findings reflect the perspectives and experiences of mothers with previous GDM within the first 3–6 months postpartum, focusing on a single rural province in Vietnam. As a result, these insights may not represent mothers’ experiences in other regions or the later stages of the postpartum period. Although the results include aspects of family support, the findings are primarily derived from women’s perspectives on their family’s views rather than directly from family members themselves. Thus, we recommend conducting similar studies in diverse geographic and cultural settings to address these gaps. It would also be beneficial to extend the follow-up period and involve family members in the interviews to capture a broader range of experiences and perspectives in this population.

Implications

These findings underscore the need to improve awareness and guidance for continued management of GDM among mothers, their families, and among health care professionals. We recommend that healthcare workers counsel and guide women and their families, addressing the specific cultural dimensions of the postpartum period in Vietnam. Improving awareness about the long-term implications of GDM, particularly the increased risk of developing T2D for both mothers and their babies, and the benefits of healthy lifestyle behaviors, is essential in motivating mothers and family members to perform GDM-compliant health behaviors postpartum.

Furthermore, to facilitate postpartum diabetes testing for new mothers, we recommend bundling testing with the child’s health check-ups or expanded vaccination sessions, making the mother’s health part and parcel of the child’s growth and development. We propose establishing clinics integrating mother and child healthcare and offering comprehensive care, including diabetes screening, nutritional and physical activity coaching and counseling, mental health support, family planning services, baby care, and expanded vaccination. By combining all services under one healthcare facility, the mothers could be facilitated to access and attend healthcare services frequently and save time during the postpartum period. Sustained postpartum and long-term follow-up by healthcare providers, alongside reliable, high-quality information disseminated through social media, are critical components for supporting women in managing their health effectively and maintaining healthy habits. The healthcare system, GDM self-care postpartum guidelines, and media platforms should take central roles in raising awareness about the long-term implications of GDM and promoting preventive measures for the future.

Conclusion

This study has explored the postpartum experiences of mothers with prior GDM in Vietnam. We found that most mothers and their families prioritize the child’s health and development, often at the expense of the mother’s continued GDM management. A low-risk perception of GDM’s long-term risks for both mothers and children, coupled with limited postpartum guidance and uncoordinated/lack of follow-up from the healthcare system, contributes to the downplaying and disappearance of GDM after birth. The mothers’ and their family members’ heightened focus on the child’s development and health caused GDM to become less important in everyday life in the postpartum period. These findings are important beyond the Vietnamese context, as they highlight the universal experience of welcoming a new family member, which attracts the attention of both the mother and her support network, potentially making the attention to GDM fade.

Abbreviations

GDM

Gestational Diabetes Mellitus

T2D

Type 2 diabetes mellitus

OGTT

Oral glucose tolerance test

Author’s contributions

All authors participated in the conception of the ethnographic study. NATD, TG, TAN, TKDV, TMPN, and VTN conducted fieldwork. Transcriptions were coded by NATD, TAN, TKDV, TMPN, and VTN, and thematic analysis was performed by TG, NATD, TAN, TKDV, TMPN, and VTN. NATD took the lead in drafting the manuscript, ARV participated in drafting and editing the manuscript, and all authors contributed to all stages of the writing. All authors approved the final version for submission and are responsible for the work.

Funding

The study was funded by the Ministry of Foreign Affairs of Denmark, grant number “21-M03-KU: Living Together with Chronic Disease: Informal Support for Diabetes Management in Vietnam, Phase II: Gestational Diabetes in Vietnam (VALID II).” The funder was not involved in the study and had no role in developing the study design, conduct, analysis, reporting, or decision to submit for publication.

Data availability

The datasets generated and/or analysed during the current study are not publicly available due to protecting the participants’ privacy but are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The Ethics Council for Biomedical Research of Thai Binh University of Medicine and Pharmacy, Vietnam, granted the project’s ethical approval on 1 December 2022 (IRB – VN01.009), registered at ClinicalTrials.gov (NCT05744856). All new mothers were informed of the purposes of the study and volunteered to sign the written informed consent before participating in the project. The women could withdraw at any time without affecting their access to health care. Furthermore, all participant information was kept confidential throughout the study process, and pseudonyms were used for all participants’ names in the article.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.