Social and Environmental Barriers to Nutrition Therapy for Diabetes Management Among Underserved Pregnant Women: A Qualitative Analysis

Objective: To identify social and environmental barriers to nutrition therapy for diabetes management during pregnancy among a population of low-income, minority pregnant women. Design: Prospective, in-depth, semi-structured interviews performed serially during pregnancy and continued until thematic saturation was reached. Setting: Urban academic medical center. Participants: Ten pregnant low-income, minority women with gestational diabetes and type 2 diabetes mellitus. Phenomenon of Interest: Social and environmental barriers to nutrition therapy for diabetes management during pregnancy. Analysis: Qualitative analysis of interview data using electronic coding software was performed using theme analysis. Results: Participants perceived limited ability and self-efficacy to adopt nutrition recommendations. Specific themes identified as barriers included (1) feeling overwhelmed by the unfamiliar; (2) using and decoding nutrition labels; (3) managing nutrition choices and seeking control in the setting of food insecurity; (4) experiencing lack of control and motivation, and limited self-efficacy; (5) balancing recommendations with taste preferences and cultural food norms; (6) maintaining a healthy eating schedule; and (7) accommodating diabetes in family and social life. Conclusions and Implications: Pregnant women with diabetes encounter a number of knowledge-based, attitudinal, and resource-related barriers that reduce capacity for nutrition therapy adherence. Provision of culturally informed, practical nutrition support that addresses the needs of women in low-resource communities is an important component of comprehensive diabetes care during pregnancy.