Exploring women's and providers' perceptions of preconception and postpartum care after gestational diabetes mellitus

Gestational diabetes mellitus (GDM) presents a growing global health challenge, particularly in low- and middle-income countries such as Zimbabwe, where it poses significant risks for both maternal and child health, including increased lifetime susceptibility to type 2 diabetes mellitus (T2DM; Ohene-Agye et al., 2024). This study addresses gaps in understanding the long-term healthcare implications and management strategies for GDM in Sub-Saharan Africa and the influence of social determinants of health (SDoH) by exploring the perceptions of affected women and healthcare providers. A qualitative phenomenological design incorporating a multi-perspective approach was employed, guided by an integrated theoretical framework combining Interpretative Phenomenological Analysis (IPA) and the Health Belief Model (HBM, Smith et al., 2022; Rosenstock et al., 1988). Data were collected through in-depth interviews and focus group discussions with 26 women and 9 healthcare providers across two urban maternity hospitals in Zimbabwe and analyzed thematically. The diagnosis of GDM imposed profound emotional and practical burdens, with women reporting fear, anxiety, and disruption of normal pregnancy experiences. Despite recognizing the severity of GDM, most women perceived low susceptibility to developing T2DM postpartum. Adherence to dietary and treatment regimens was hindered by stigma, food insecurity, and limited support networks. Healthcare providers, though biomedically knowledgeable, operated under severe systemic constraints, including high workloads, inadequate training, and lack of national postpartum guidelines. The study underscores the urgent need for integrated, patient-centered, and culturally sensitive GDM care in Zimbabwe, emphasizing universal screening, structured postpartum follow-up, and multidisciplinary collaboration. Policy reforms should institutionalize national GDM guidelines and address social determinants through multisectoral interventions. Theoretically, this research demonstrates the value of integrating IPA and HBM in elucidating how emotional, behavioral, and structural factors intersect to shape maternal health outcomes.