Table 2 Data to support identified themes

1

Initial psychological impact

‘I was very surprised and very upset to be diagnosed. I felt a little bit of a failure.’ [31]

‘You actually feel guilty, right? Because this baby hasn’t asked for this; and what if the baby comes out and has some kind of disease? Then it’s my fault.’ [58]

‘GDM was a hidden blessing for me... GDM can go away after you have the baby but diabetes is not so easily fixable …I am much more aware of [the] need to prevent it.’ [32]

‘It’s also good with my diabetes diet I ended up weighing pretty much the same at the end of the pregnancy as I did at the beginning.’ [31]

2

Communicating the diagnosis

‘Like they don’t have time to sit there and talk to you about what to do about it [GDM], but they are always in a hurry [………] so I just don’t bring it up and they don’t bring it up; so you just get checked out and leave.’ [26]

‘They sent me off to the dietician and I came out depressed....I went “nuh - if I eat what you’re telling me”... and she was telling me I had to eat carbs with every meal. I knew it wouldn’t control my BSL [blood sugar level]...hadn’t they read the latest research about a high protein diet being more beneficial that a high carb diet? [32].

‘scared that if the sugar was too high they would take the baby out [33].

‘Nobody told me anything about type 2 diabetes...they were so focused on the immediate pregnancy problems; within a medical model...OK, if we don’t get it under control, we will just put you on insulin... just a drug solution.’ [32]

‘They [hospital dieticians] don’t have much information on for example some Chinese dishes, so I would go on the Internet and check if they’d raise my blood sugar. .. but even on the Internet, it’s hard to find information like that.’ [62]

3

Knowledge of GDM

‘I thought it was the end of the world because I didn’t fully understand it’ [27].

‘At first I thought: it must be because I ate a lot sweet, overweight ... but then I was talking to the girl, she said it must be family, right??’ [57]

‘My husband, he always knew me like this ... is ... healthy, without any illness. [...] Because he is kind of ignorant in these matters, you know. He thinks that diabetes ... that I’m dying! ... And my boy too, is half pensive, cautious, thinking I’m going to die.’ [57]

‘I did not know that rice can have that much sugar. That’s one thing really, really surprised me. I’m thinking that sugar normally comes from cakes and chocolate.’ [31]

I’ve eaten something and I’ve thought my reading’s not going to be good after this and it’s been fine. So it was mainly getting my head around it’s not just the sugars. Like Special K for example. That was on my list of things that I could have and then the lady (educator) said, ‘What did you have for breakfast? And I said I had Special K. She said, ‘it obviously doesn’t work for you. So you either have to up your insulin, if you want to just keep eating Special K, or just stop eating it.’ [31]

‘You’d think, okay, well this will be good; this will be fine for me to eat. Then I will check my sugars 2 h later and it would not. I would be why? That’s not okay. It was disappointing, and it was definitely stressful, like it was just really not fun.’ [46]

If the mother breastfeeds her baby the ‘diabetes factor’ may transmit to the baby and it’s no good. It may make the baby have the same disease afterwards’ [39]

‘I’m concerned about that (transmission of diabetes to the infant) of course’ [39]

4

Risk perception

‘coming back as borderline gestational diabetes wasn’t such an issue as having full-blown diabetes...and I don’t worry about it.’ [38]

‘I’m afraid this diet won’t provide enough nutrients for the baby, but the doctor told me to do that’ [38]

‘since, after giving birth and everything’s back to normal so I’ve sort of been making up for lost time a little bit with all the chocolate I couldn’t have.’ [52]

‘It’s actually quite odd that during birth, they monitored everything closely, and as soon as I had delivered they served me a piece of white bread.’ [52]

5

Managing GDM

‘It is frustrating still when you watch your carbs, you portion it and your reading is still high, almost every day.’ [46]

‘I’ve been doing everything right. My sugar is so unstable. The highest reading was 202 with my insulin. I have eaten the right foods, exercised, and tested my glucose levels four times a day. I had some high ones of 151. When my insulin dosages are increased, I am more depressed. I feel worthless.’ [49]

‘I really wanted to control it through my diet and exercise. I was strongly motivated to do all I could so I didn’t have to introduce another needle.... But when I went on insulin I relaxed.’ [32]

‘..my baby might die if I’m not on [a] diet.’ [39]

‘Well, you are deviant from others. It’s like a functional handicap in that aspect’ [15].

‘I’m a full-time working mom, so I had to carry a little refrigerator with me with the insulin to work every day and on weekends to the restaurant and have to hide in the bathroom. It made me feel like I’m totally an illegal person.’ [35]

6

Burden of GDM

‘The whole pressure with the whole everything, it really did affect me and I think it’s probably one of the worst times I’ve had in my life actually.’ [53]

‘I would have crashes where I’d be driving on the freeway, and I’m at a crazy low number, and I have to try to find some candy or something in my car. So it was very frustrating.’ [35]

‘because it is really ugly to have, in fact I wanted to have another baby and since I got this I do not want to anymore.’ [14]

7

Social support

‘Well, I wouldn’t have done it without my partner like because he was like, “Up, eat now, insulin,” you know, and I would be, “Yeah, I’m going to get up in 20 min and I’m going to do this,” and he was like, “Now, eat, your insulin,” you know.’ [21]

‘he’s now cooking more for me and he’s healthier because he doesn’t, because if he’s going to eat junk food that’s just going to make me jealous. So he’s kind of trying to eat healthy as well for me.’ [31]

‘My mother-in-law phoned relatives and told the villagers that my baby was not healthy because I had GDM...’ [37]

8

Gaining control

‘You have an active role and you can take charge of what’s going on rather than just roll along.’ [12]

‘I believe in not giving in to diabetes. I will take care of myself and control the diabetes.’ [49]

‘I looked at herbal remedies because that’s something that [laughing], you know, you think is quite safe [21]