Understanding interconception experiences of women with previous gestational diabetes mellitus across Ireland

Abstract

Aim

To explore the interconception experiences of women after GDM across Ireland to inform how to optimise health between pregnancies.

Methods

A qualitative descriptive study was implemented. Online semi‐structured individual interviews were conducted (April–May 2025) with women living on the island of Ireland who had experienced GDM ≤5 years ago. Data were transcribed and analysed inductively using reflexive thematic analysis.

Results

Twenty‐seven women participated, and four themes were generated: (1) Shaping health behaviours beyond pregnancy, (2) GDM's emotional legacy, (3) Understanding interconception care and future risk management and (4) Interconception needs and support preferences.

Conclusions

This study provides novel insights into women's interconception experiences following GDM across Ireland and shows behavioural, emotional and healthcare‐related impacts between pregnancies. Although education received during pregnancy facilitated behaviour change that persisted postpartum, maintaining GDM‐related positive health behaviour changes was often challenging without ongoing support. Postpartum care gaps and a lack of interconception support left women uncertain about their future GDM risk and appropriate pregnancy preparation. These findings highlight the need for interconception care including timely postpartum follow‐up, clearer communication about recurrence risk and accessible preconception support for women planning a subsequent pregnancy.

What's new?

• What is already known? Very little is known about women's interconception experiences after gestational diabetes mellitus (GDM) across Ireland.

• What this study has found? Behavioural, emotional and healthcare‐related consequences are experienced by women after GDM. Behaviour change initiated during pregnancy was often difficult for women to maintain. Gaps in postpartum care and a lack of interconception support left women uncertain about future GDM risk and prevention.

• What are the implications of the study? Interconception care should include timely postpartum follow‐up, clearer communication about recurrence risk and accessible preconception support for women planning a subsequent pregnancy.

1. INTRODUCTION

Gestational diabetes mellitus (GDM), defined as hyperglycaemia first detected during pregnancy, ¹ is a common pregnancy complication that remains under‐recognised in terms of its short‐ and long‐term health implications among women and within healthcare systems. GDM affects approximately 14% of pregnancies globally ² and 5.9% in Ireland ³ and recurs in up to half of subsequent pregnancies. ⁴ Although GDM typically resolves after birth, it is associated with longer term health consequences for mothers and their children, including an almost tenfold increased risk of developing type 2 diabetes in the mother. ⁵

Across Ireland, following a pregnancy with GDM, guidelines recommend HbA1c screening or an oral glucose tolerance test at 6–12 weeks postpartum to identify persistent hyperglycaemia, followed by annual monitoring in primary care, alongside support for chronic disease prevention, family planning and contraception. ¹ , ⁶ , ⁷ These models of care are broadly consistent with international postpartum guidance focusing on early detection of persistent dysglycaemia, long‐term diabetes risk reduction through lifestyle and monitoring, and proactive preparation for future pregnancies. ¹ , ⁸ Where postpartum programmes for women with previous GDM are available internationally, they have largely been designed to reduce longer term risk of type 2 diabetes through diet and physical activity interventions. ⁹ However, programme availability, delivery setting, follow‐up duration and engagement vary, which may limit their effectiveness and leave interconception needs under addressed. ¹⁰ , ¹¹ Furthermore, women planning pregnancy after GDM have higher rates of obesity, ¹² and despite this, evidence for interconception interventions targeting modifiable risk factors for GDM recurrence remains limited. ¹³

To date, qualitative research on women's experiences of GDM has largely focused on pregnancy, with limited attention to the interconception period. ¹⁴ , ¹⁵ , ¹⁶ A systematic review of women's experiences after a GDM pregnancy further indicates that psychological impacts are compounded by practical challenges, as women prioritise caregiving responsibilities over their own health. ¹⁷ Emerging qualitative research in the United Kingdom (UK) has begun to explore women's preconception perceptions, knowledge and behaviours after GDM, highlighting gaps in risk understanding, barriers to maintaining behaviour change and variation in pregnancy preparation. ¹⁶ However, this work drew primarily on interviews conducted during pregnancy and focused mainly on preconception, rather than the broader lived experience of the interconception period. Consequently, little is known about how women with previous GDM navigate the period between pregnancies, including how postpartum care experiences, perceptions of recurrence risk and support needs influence preparation for a subsequent pregnancy.

Exploring the interconception experiences of women with previous GDM is essential to identify opportunities to optimise preparation for a subsequent pregnancy through interconception health and care. Therefore, this study aimed to explore the interconception experiences of women with previous GDM across Ireland.

2. METHODS

2.1. Study design and theoretical perspective

A descriptive qualitative study design ¹⁸ was used to understand women's experiences and perceptions during and after pregnancy impacted by GDM. This study adopted a relativist ontology to acknowledge that reality is based on an individual's experience and context. ¹⁸ , ¹⁹ The study was conducted within the epistemological paradigm of interpretivism, acknowledging that knowledge is subjective and that it is created through a lens of interpretation.

Individual semi‐structured interviews were conducted. ²⁰ An interview schedule was developed in consultation with members of the research team and informed by GDM, pregnancy and postpartum health literature. ²¹ , ²² The schedule covered topics such as women's experience of being diagnosed with and managing GDM, postpartum care and support, and pregnancy planning and preparation after experiencing GDM (Table S1). The interview schedule was piloted with one woman with previous GDM, which was used to refine the interview schedule, but the pilot interview data were not included in the final analysis. ²¹ , ²²

The consolidated criteria for reporting qualitative research interviews and focus groups and Reflexive Thematic Analysis Reporting Guidelines were used to guide reporting. ²³ , ²⁴

2.2. Reflexivity

Reflexivity and authors' positionality were important aspects throughout the research. The first author (CVG) who conducted the interviews has a background in nutrition and population health with 4 years' experience conducting and analysing qualitative interview data focused on pregnancy and postpartum. She has not experienced a pregnancy or GDM which was acknowledged as a potential influence on data collection and analysis.

The wider research team brings complementary expertise in qualitative and quantitative research methods in the fields of diabetes, psychology, behavioural science, nutrition and women's health, as well as, varied professional backgrounds and differing personal experiences of pregnancy. These perspectives were actively reflected upon during data analysis. Coding and theme development were conducted iteratively, with regular team discussions to challenge assumptions, and consider alternative interpretations.

2.3. Ethical approval

The study was conducted in accordance with the Declaration of Helsinki and approved by the Royal College of Surgeons in Ireland Ethics Committee in February 2025 (REC: 202411032).

2.4. Participants and recruitment

Participants from the Republic of Ireland (ROI) or Northern Ireland (NI) who had recently experienced a pregnancy with GDM (≤5 years) were recruited using purposive sampling. A recall period of ≤5 years was selected to capture experiences across the interconception period, recognising variability in pregnancy spacing and allowing exploration of how perceptions and needs may differ over time. The island of Ireland comprises two jurisdictions with separate governments, healthcare systems, funding structures and clinical guidelines. In the ROI, services are delivered through the Health Service Executive, while in NI they are provided through the Health and Social Care system. Despite these differences, participants' experiences were largely convergent across both jurisdictions, and findings are therefore presented from an all‐island perspective.

Social media, (e.g. Facebook, Instagram, LinkedIn) using unpaid posts and word of mouth via snowballing sampling were utilised to recruit potential participants. ²⁵ Recruitment materials were disseminated across a range of community, parenting and health‐related platforms, relevant Facebook groups, organisational pages and professional networks to enhance sample diversity across sociodemographic and geographic groups. All participants were provided with a participant information sheet and gave informed consent electronically online prior to participation and again at the beginning of the interview. A short questionnaire was completed before the interview to collect demographic information and screen for non‐genuine participants. To minimise non‐genuine participation, the research team asked participants to be on camera during the interview to verify participant authenticity. Upon completion of all interviews, participants received a €30 gift voucher as compensation for their time.

2.5. Data collection

The interviews were conducted online via Microsoft Teams between April and May 2025 at a time convenient for the participants. Each interview lasted between 25 and 64 min (M_Time = 43 min). Field notes were made after each interview to manage the researcher's reflections on their positionality. The concept of information power to guide the sample size adequacy was utilised. ²⁶ The sample was assessed as having sufficient information power, given the focused aim and tight sample specificity of the study, and the experience of the moderator and wider research team to generate focused and rich data.

2.6. Data analysis

Interviews were audio recorded, transcribed by Microsoft Teams, checked for accuracy manually by listening to the audio, de‐identified and securely stored in encrypted password protected files. Pre‐interview survey data were summarised using STATA 19. Transcripts were imported into NVivo v.15. Two authors (CVG, LJ) independently analysed the data in duplicate for the initial stages of thematic analysis ²⁷ including (1) familiarisation with the data and (2) generation of initial codes. Subsequent stages: (3) searching for themes, (4) reviewing themes, (5) defining and naming themes and (6) producing the report were led by one author (CVG), with regular input and discussion with the wider research team. ²⁷ Inductive, reflexive thematic analysis was chosen to examine each participant's' perspectives, highlighting similarities and differences and uncovering expected and unexpected insights. ²⁷ , ²⁸ Themes were named and each represented a pattern of shared meaning underpinned by a central organising concept rather than summarising the data. Four researchers (CVG, ACF, PD and SAS) reviewed and challenged each theme through critical dialogue. Direct quotations were extracted from the data to illustrate each theme. All responses were anonymised and names replaced with pseudonyms.

3. RESULTS

Twenty‐seven women (ROI n = 22, NI n = 5) from 16 counties across the island of Ireland were interviewed. Most identified as white (82%), were aged between 30 and 34 (37%), held a postgraduate degree (59%) and were employed full‐time (67%). Four women were pregnant at the time of interview and experiencing their second or third GDM pregnancy (M_Weeks = 26 weeks). Among postpartum women (n = 23), time since birth ranged from 1 to 54 months (M_{Months Postpartum} = 18 months) (Table 1).

TABLE 1.

Characteristics of participants (n = 27).

Participant characteristics	n (%)
Age
25–29	3 (11.11)
30–34	11 (40.74)
35–39	9 (3.33)
40‐older	6 (22.22)
BMI (self‐report)
18.5–24.9 kg/m2	5 (18.52)
25.0–29.9 kg/m2	8 (29.63)
30.0–39.9 kg/m2	9 (33.33)
≥40.0 kg/m2	4 (14.81)
Ethnicity
White (Irish/Northern Irish/Other)	22 (81.48)
Asian	1 (3.70)
Black/African/Caribbean/Other	3 (11.11)
Mixed	1 (3.70)
Place of residence
Republic of Ireland	22 (81.5)
Carlow	1 (3.70)
Cork	1 (3.70)
Donegal	2 (7.40)
Dublin	8 (29.63)
Galway	2 (7.40)
Kildare	2 (7.40)
Leitrim	1 (3.70)
Mayo	1 (3.70)
Meath	1 (3.70)
Offlay	1 (3.70)
Roscommon	2 (7.40)
Northern Ireland	5 (18.5)
Antrim	1 (3.70)
Down	1 (3.70)
Fermanagh	1 (3.70)
Derry	1 (3.70)
Tyrone	1 (3.70)
Location of residence
Urban	7 (25.93)
Town	11 (40.74)
Rural	9 (33.33)
Education
Leaving certificate	1 (3.70)
Degree or equivalent	10 (37.04)
Postgraduate degree or equivalent	16 (59.26)
Employment
Employed Full‐Time	18 (66.67)
Employed Part‐Time	4 (14.81)
Full‐time parent	4 (14.81)
Unemployed	1 (3.70)
Pregnancy status
Pregnant	4 (14.81)
Number of children
1	12 (44.44)
2	9 (33.33)
3	3 (11.11)
4	4 (14.81)

Four themes were developed: (1) Shaping health behaviours beyond pregnancy, (2) GDM's emotional legacy, (3) understanding interconception care and future risk management and (4) interconception needs and support preferences (Figure 1).

FIGURE 1.

Themes and subthemes capturing the interconception experiences of women with prior.

3.1. Theme 1: Shaping health behaviours beyond pregnancy

This theme consists of three subthemes and describes how education received during pregnancy influenced women's postpartum health behaviours, while also highlighting the practical challenges of maintaining dietary and physical activity changes and managing weight in the absence of ongoing support.

3.1.1. Lasting influence of GDM education on health behaviours after pregnancy

Some women described how the education received during pregnancy had a lasting influence on their dietary and physical activity behaviours postpartum. Positive changes adopted such as greater thoughtfulness about meal composition, pairing carbohydrates with protein, reading food labels and incorporating post‐meal walking or light daily activity were often maintained.

My diet has changed since then and I think that was the great outcome of it. Almost it felt like you had a crash course in understanding how your body processes food…I also spend more time than I'd ever had, like I never used to look at what was in foods … [reading] the [ingredient] panel [of a food label], and look at the sugar content… I don't have a perfect diet now, but I'm more mindful of, you know, either choosing something to really enjoy it and like, OK, let's have that versus just having random stuff that happens to have sugar in it just feels a bit pointless now‐Anna, 32 months postpartum

3.1.2. Challenges to maintaining diet and physical activity changes

Navigating the transition to motherhood and caring for a newborn were spoken about as challenges to maintaining behaviour changes after pregnancy. Most women described changes in routines, limited time for food preparation, physical activity or themselves during the postpartum period. Physical activity was often the behaviour that women stopped engaging in due to limited motivation, time or uncertainty of what to do beyond walking.

Do you know I've actively tried to get back on [GDM diet] just for my own health, you know, several times. Still haven't achieved it yet because most of the things take such a long time to make and so there's a lot of preparation with everything. It's not something you can pick up… It is extremely difficult with the baby… It's not really sustainable for me currently anyway, with a very small kid, the baby at home and my husband working‐ Chloe, 4 months postpartum

For some women, a lack of culturally relevant dietary advice during pregnancy rendered any changes as unsuitable to continue postpartum.

[During pregnancy] I had no clear guidance on African foods. Just generic carb counting advice. And I experimented a lot with smaller portions of rice. Tried more vegetables. Adding beans or sauces to balance things out…None of the materials they gave me talked about my cultural background… But when I asked about eating plantain and cassava, [the dietitian] looked completely blank… It was hard to navigate… So once the baby arrived, I obviously didn't keep any of those changes‐Nadine, 4 months postpartum

3.1.3. Navigating postpartum weight change

Women described the mental and physical challenges of navigating postpartum weight in the absence of ongoing support from healthcare professionals. Weight regain was common, particularly among those who had lost weight during pregnancy. Many were uncertain how best to manage these changes, and in some cases lose weight regained.

I hope that I will go back on [the GDM diet] because it was good, my health definitely did improve … but now what do I do? … I feel like I've undone all the good since I've gained weight‐Chloe, 4 months postpartum

3.2. Theme 2: The emotional legacy of GDM

Three related subthemes were generated that capture the lasting emotional impact of GDM beyond pregnancy, which influenced how women entered the interconception period.

3.2.1. Residual guilt and retrospective fear

Women reflected on GDM post‐pregnancy and questioned whether their own behaviours or knowledge gaps contributed to developing the condition. While women emphasised that previous GDM would not change their plans for future family planning, they described that a subsequent diagnosis would likely trigger these similar feelings, including guilt related to their lifestyle choices or body weight and fear of the perceived impact on child health.

I just felt so guilty [about the GDM diagnosis]. I remember I burst into tears … I was like, oh, my God, what the *** do I do now … Was I eating really ****? Maybe I was because of a lack of knowledge. Pure ignorance … I think if I was to go back and have a third pregnancy … it wouldn't change that choice I just probably won't have forgotten [the negative experience and emotions], and I would probably still cry and be shocked‐Lucy, 4 months postpartum

This emotional burden led women to distance themselves from the pregnancy after birth.

And it was the fear… I wanted to keep lots of things as a normal pregnancy, keep it as like low risk as possible. I didn't tell many people I had [GDM]. I really didn't want to be high risk…So, I think once I gave birth, I just closed that chapter‐Isabelle, 7 months postpartum

3.2.2. Enduring weight stigma

Stigma, particularly related to weight influenced women's emotional experiences during pregnancy which persisted after pregnancy. Women described assumptions from peers, family and healthcare professionals that lifestyle choices had caused their GDM.

I only really viewed [GDM] with negative connotations. I'm a larger woman, so it would have automatically been assumed that my lifestyle and my choices prior to pregnancy would have been a direct correlation with having GDM … I suppose the word diabetes is negatively assumed with type 2 diabetes and you think that it's related to lifestyle choices … so I suppose for somebody who struggles with weight all their life, it's now another kind of chip to bear.‐Ciara, 3 months postpartum

3.2.3. Internalised anxiety around food following the restrictive GDM diet

Several women shared how having GDM created an unhealthy relationship with food after pregnancy. The highly prescriptive nature of the GDM diet led to continued anxiety and negativity around eating after pregnancy.

I realised afterwards that [GDM diet] actually created a really negative mindset around food. It really created a very negative mindset… and now I wouldn't be the skinniest. I've never been, you know… I've always had an issue with my weight, but that created an insane amount of panic with food now afterwards‐Niamh, 36 months postpartum

3.3. Theme 3: Understanding interconception care and future risk management

Comprising four subthemes, this theme presents women's experiences of the interconception period following GDM, illustrated by a perceived discontinuity in care, limited access to preconception information and varied perceptions of recurrence risk that influenced their approaches to preparing for a subsequent pregnancy.

3.3.1. The perceived drop‐off in care after pregnancy

Women described the transition from intensive antenatal GDM management to minimal or no postpartum follow‐up as a sudden drop‐off in care, occurring at a time when they were managing a newborn, recovering physically and attempting to make sense of their own health. The absence of appointments or opportunities to ask questions contributed to feelings of being abandoned and unsupported once the pregnancy had ended.

It's such a broken system. While you're pregnant, you're this thing that they have to micromanage … calling up every week [about blood glucose readings] … then you have your baby and everything drops off immediately.‐Rosie, 9 months postpartum

3.3.2. A gap in preconception information and support

Women described a gap in interconception information and guidance for women with previous GDM. Many women spoke about an absence of educational information both during and after pregnancy, leaving them uncertain about what to expect in subsequent pregnancies and how to manage their risk.

What do I do going into another pregnancy, you get little to no support before you hit twelve weeks, so you know, I kind of felt like I'm on my own there. But if there was somewhere to go, you know, just to go and check, like, you know, I had gestational diabetes the last time, what should I do in the first twelve weeks? Should you change your diet straight away? Should you be checking your blood sugars? Do you know that kind of thing and also somewhere to get good information?‐Róisín, 17 weeks pregnant

All women highlighted the need for GDM to be included in interconception conversations between women and healthcare professionals, in a similar way to folic acid. They felt that GDM is common enough to warrant earlier discussion with GPs, public health nurses and to be included in national health resources.

I think generally, you're told to take folic acid, you know, like a few months before, I think [GDM] needs to be part of that conversation, to be honest, just especially with the fact that so many women get it…. When you go on a HSE website, it needs to be part of that conceiving page‐Sophie, 18 months postpartum

3.3.3. Assumed inevitability of GDM recurrence

The women varied in their understanding of future GDM risk. For some women, there was a sense of inevitability and a lack of control over developing GDM again; therefore, it was not something that could be influenced before a next pregnancy. Communication on future risk from healthcare professionals also conveyed a feeling of inevitability among almost all women, reinforcing the belief that recurrence is largely predetermined rather than potentially modifiable.

I don't think [GDM] is something that I can prevent. So, I just think what's the point you know if it's something that you could prevent happening like type 2 diabetes if we can help to prevent that because this is hormone driven. I just don't think prenatally anything would change. I think you need the information when you have [GDM]… I didn't really consider it prenatally at all. I just felt it was totally out of my control.‐Keira, 30 weeks pregnant

3.3.4. Pregnancy preparation after GDM

Some women spoke about being proactive and preparing for pregnancy, informed by the expectation that GDM is likely to recur. Women described reverting to the routines they followed during their previous pregnancies. In contrast, some women made no adjustments and were not aware any changes were recommended or necessary.

I suppose I'm kind of at that position now where we're hoping to start trying for a baby again. So, I have really gone back into it now like I almost feel like I'm back pregnant because of the stuff I'm eating is basically what I ate when I was pregnant because I'm really conscious that, you know, this is probably going to happen again. Let's kind of get ahead of it‐Gemma, 14 months postpartum

For other women, they planned to restart the GDM diet or adopt healthier habits upon confirming pregnancy, rather than before pregnancy, often due to perceived inevitability of recurrence.

I am planning to have another baby, and I do know that the risks are pretty high that I will have GDM again. My plan is to once I find out I'm pregnant, is to just start the diet and follow the schedule that I was on previously‐Rosie, 9 months postpartum

3.4. Theme 4: Interconception needs and support preferences

This theme describes women's preferences for interconception support following a GDM pregnancy, including the timing and format of information delivery, the need for culturally relevant guidance, and a preference for practical strategies to support behaviour change.

3.4.1. Preferred delivery of information and support

Women highlighted that immediately after birth was an emotionally, physically, and logistically demanding period and not optimal for interconception education or advice. Instead, most women recommended later timepoints, such as 3–6 months postpartum or aligning with postpartum screening tests. Women spoke about preferring digital platforms including video‐based content, curated websites, pre‐pregnancy webinars, and app‐based tools that allowed information to be accessed and revisited at their own pace. Additionally, resources by evidence‐based organisations or healthcare professionals that integrated lived experience alongside clinical guidance were viewed as relatable and trustworthy.

If they [healthcare professionals] can create something pre‐pregnancy that will be great, because normally [healthcare professionals] just want to see you during pregnancy. That way maybe for someone who is planning to be pregnant and has a history of GDM, they could have an online session like a webinar or something.‐Ella, 1 month postpartum

3.4.2. Cultural and family inclusive content

Women from minority ethnic backgrounds discussed the need for culturally relevant guidance, particularly for minority ethnic groups whose traditional foods are not represented in standard advice received during pregnancy, in addition to their inclusion in wider care considerations and research in Ireland.

… going through GDM in my second pregnancy opened my eyes to just how underrepresented and undeserved women of African women are in what medical care and research here in Ireland‐Nadine, 4 months postpartum

Women also spoke about resources designed for partners and older children to increase awareness of GDM within the household.

So, my husband has not the slightest notion of what I'm going through… So, if there's something for GDM that he could read and be like, oh, this is actually coming from professionals… and then [name] because she's seven. She's just full of questions and it's very difficult for me to put it in a way that she'll understand‐Róisín, 17 weeks pregnant

3.4.3. Practical and behaviour change‐oriented guidance

Women wanted resources that acknowledged the realities of postpartum life and offered practical advice. This included educational, step‐by‐step guidance on incorporating dietary and physical activity changes postpartum, including tailoring GDM education resources for after pregnancy.

After delivery, having a structured plan of whether we introduce exercise would be valuable and this programme should be designed to help mothers get back into fitness‐Nadine, 4 months postpartum

Connecting, online and in‐person, with others who had experienced GDM was described as important. Women felt less isolated when they discovered that peers had similar experiences during pregnancy, and these interactions were viewed as motivating to maintain healthy behaviours postpartum.

Maybe even like a little support group or something like that … because I think talking to [other women with previous GDM] definitely helped me stay focused [to make changes] like I found out afterwards that I had friends who had gone through it too and they'd been too embarrassed to say … that shared experience even now [postpartum] is important‐Olivia, 7 months postpartum

4. DISCUSSION

This qualitative study explored the interconception experiences of women with previous GDM across Ireland. Women described increased health awareness postpartum but challenges maintaining behaviour change in the absence of ongoing support in addition to lasting emotional effects, including guilt and stigma. A gap in interconception care left women uncertain about future GDM risk, resulting in varied levels of preparation for subsequent pregnancies. Together, these findings highlight the importance of the interconception period to address the legacy of GDM and to optimise health and reduce the risk of GDM recurrence in subsequent pregnancies.

Consistent with previous evidence in the UK, ²² women in this study described how dietary and physical activity education received during GDM management had a positive influence on postpartum behaviours, including pairing carbohydrates with protein, reading food labels, and engaging in post‐meal walking. However, maintaining these changes was often challenging due to competing postpartum demands, whilst weight regain was commonly reported. ²² , ²⁸ , ²⁹ Although GDM management may facilitate initial behaviour change, the absence of postpartum support may undermine longer term maintenance of healthy behaviours. ³⁰ Similar barriers are documented in type 2 diabetes prevention. ³¹ Currently, there are no postpartum programmes across Ireland to support women with previous GDM in maintaining behaviour changes, reducing GDM recurrence risk and optimising longer term metabolic health, a gap which needs to be urgently addressed.

In this study, the emotional consequences of GDM persisted postpartum, with women describing residual guilt and stigma, and a desire to ‘close the chapter’ following delivery. These findings are consistent with qualitative research from the UK and Australia which similarly report ongoing feelings of guilt and shame after pregnancy, ²⁸ , ²⁹ potentially influencing women's willingness to engage in type 2 diabetes screening and future family planning discussions. ²² Despite this, current GDM care remains predominantly focused on glycaemic management during pregnancy. Incorporating psychological support and stigma free communication into antenatal and postpartum care may help reduce distress and stigma for women with GDM during and after pregnancy. ¹⁶

Women in this study perceived an immediate withdrawal of support and inadequate care following delivery, with limited postpartum follow‐up, which has been described previously. ³² In addition, the absence of interconception information and support left women uncertain about their risk of GDM recurrence. This lack of guidance contributed to varied risk perceptions, including a belief among some women that recurrence was inevitable which is consistent with previous UK evidence. ²² Although responsibility for postpartum follow‐up across Ireland is largely situated within primary care and public health nursing services, the absence of standardised care pathways, variability in recall systems and ongoing pressures within primary care may result in limited continuity of care after pregnancy, ⁹ , ³³ which limits opportunities for GDM risk communication for subsequent pregnancies and longer term health. Addressing these gaps may require the development of an interconception care pathway for women with GDM, which includes a standardised recall system and improved integration between primary and secondary care. The newly formed postnatal hubs in Ireland may also provide an opportunity to continue care after pregnancy for women who had GDM. ³⁴

Women varied in how they responded to GDM recurrence risk in the present study. Some women engaged in proactive pregnancy preparation and incorporated changes in diet and physical activity, whilst others delayed changes until pregnancy confirmation or made no adjustments, which has not been reported previously. These findings indicate the need for interconception counselling to support women with previous GDM in preparing for future pregnancies. Current care after GDM focuses primarily on reducing longer term risk of chronic disease with minimal attention on pregnancy planning to support women with previous GDM to optimise their health before a subsequent pregnancy. ³⁵ Although the emphasis of care may differ depending on pregnancy intentions, an interconception care pathway is needed to address both long‐term health and future pregnancy preparation in women with previous GDM. Equally, this pathway should be sufficiently flexible to accommodate differing pregnancy intentions. Additionally, women in this study identified preferences for future support to optimise interconception health, including information delivered beyond the immediate postpartum period when women are more receptive, accessible digital resources, culturally relevant dietary guidance, family inclusive education, practical behaviour change support tailored to postpartum realities and opportunities for peer support. These insights may inform the co‐design and development of future resources to optimise interconception care and support for women with previous GDM.

4.1. Strengths, limitations and future directions

This study has several strengths, including the first in‐depth qualitative exploration of the interconception experiences of women with previous GDM across Ireland. The interview schedule was piloted and refined with input from a woman with lived experience of GDM. The data represents a geographically diverse sample and was analysed using reflexive thematic analysis, with coding and theme development undertaken through iterative, team‐based critical dialogue. Some limitations of this study should be acknowledged. While over a fifth of the participants were from diverse ethnic backgrounds, higher than previous related research in Ireland, ²¹ , ³² , ³⁶ the participants were predominantly white‐Irish/European and educated to degree level, which limits transferability to other populations. Future research, both in the context of Ireland and wider, should consider non‐White populations a priority group, while also exploring other demographic factors which may intersect with pregnancy and GDM (e.g. socio‐economic deprivation; disability and chronic health conditions; substance misuse and other social complexities).

5. CONCLUSION

This study provides novel insights into interconception experiences after GDM across Ireland, demonstrating that GDM has behavioural, emotional and healthcare‐related impacts which extend beyond pregnancy. While pregnancy education facilitated positive health behaviours, maintaining these changes postpartum was often challenging in the absence of ongoing support. Substantial gaps in interconception care left women uncertain about future GDM risk and how to effectively prepare for subsequent pregnancies. Interconception care should include timely postpartum follow‐up, clearer communication about recurrence risk, and accessible preconception support for women planning a subsequent pregnancy.

FUNDING INFORMATION

This research was funded by a PhD studentship from the Cameron Scholars Programme in the School of Population Health at RCSI University of Medicine and Health Sciences.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest. CVG is supported by a PhD studentship from the Cameron fund in the School of Population Health at RCSI University of Medicine and Health Sciences. DS is supported by the National Institute for Health and Care Research (NIHR) through an NIHR Advanced Fellowship (NIHR302955) and the NIHR Southampton Biomedical Research Centre (NIHR203319). MB is supported by the National Institute for Health and Care Research (NIHR) through an NIHR Advanced Fellowship (NIHR304430).

Supporting information

Table S1.