Background
Gestational diabetes mellitus (GDM) affects one in six Australian pregnancies, impacting short- and long-term health outcomes for mothers and their offspring. Early intervention through nutrition, physical activity, and supporting recommended weight gain can reduce GDM risk for some women. Maternity care provides a critical opportunity to address these modifiable health risks. However, messages promoting these behaviours may inadvertently reinforce stigma and disengagement. This study aimed to explore consumer and midwife perspectives to inform effective, non-stigmatising messaging to support health-promoting behaviours that reduce GDM risk.
Methods
A qualitative study using reflexive thematic analysis was conducted across two cohorts: (1) women who had experienced pregnancy within the past five years (18 focus groups; n=130), and (2) practising midwives in public antenatal services (9 focus groups; n=52). Purposive sampling ensured diversity in body size, GDM experience, language background, and care settings. Semi-structured focus groups explored experiences with maternity care and responses to messaging related to nutrition, physical activity, weight, and GDM prevention. Analysis focused on identifying approaches that were acceptable, feasible, minimised stigma, and factors influencing prioritisation within clinical care.
Results
Both consumers and midwives preferred behaviour-focused messaging (nutrition, movement, help-seeking) over risk or weight focused approaches. Consumers valued strengths-based, flexible messaging aligned with their lived experiences. Consumers considered weight and GDM information appropriate when delivered sensitively, individualised with clear clinical rationale and reassurance.
Midwives favoured framing that centred overall health and wellbeing. GDM risk reduction alone was not a strong driver for conversations and could undermine trust.
Midwives identified structural barriers to prioritising these conversations, including time constraints, competing clinical demands, and variable care models. Facilitators included integrating messaging into routine care, using inclusive and non-directive language, and aligning discussions with women-centred care values. Midwives were more motivated by messages that reinforced their role in building trust, highlighted women’s experiences, and was supported by practical tools and system-level endorsement.
Conclusion
Values-based, behaviour-focused messaging is acceptable to consumers and aligned with midwifery practice. To maximise impact, health systems can embed messaging into guidelines, workflows, and training; and reinforce leadership priorities that position health-promoting conversations as core care.