How to improve uptake and adherence to dietary trials in gestational diabetes amongst South Asian women: insights from patient and public involvement and engagement.

BACKGROUND: Gestational diabetes mellitus (GDM) is associated with adverse maternal and neonatal outcomes and affects approximately 10-20% of pregnancies in the UK. The prevalence of GDM among South Asian women is around twice that of White British women, and they are also twice as likely to develop type 2 diabetes following diagnosis. Although multiple dietary interventions have been explored to improve glycaemic control in GDM, no single dietary approach has proven consistently effective in improving health outcomes.We conducted a patient and public involvement and engagement (PPIE) activity with South Asian women to inform a trial evaluating the acceptability, feasibility, and safety of an intermittent low-energy diet (ILED) in GDM. PPIE input was particularly valuable in addressing lower-than-anticipated recruitment and retention, especially among South Asian women, and provided insights into sociocultural barriers and facilitators to improve trial design and participation. METHODS: Six South Asian women with lived experience of overweight or obesity in pregnancy, either personally affected by gestational diabetes or with close family experience, participated in one-to-one discussions lasting up to 60 minutes to provide feedback on trial procedures, methods, and design. Based on these insights, a follow-up discussion group was conducted with eleven South Asian women who had been pregnant in the last five years, were currently pregnant, or planning pregnancy, and who had experience of overweight/obesity or GDM. Key priorities were identified and translated into practical action points to inform ongoing research. CONCLUSIONS: Three key priorities emerged as a potential means of enhancing engagement with South Asian women: addressing vulnerability (including trust and loss of control), improving accessibility, and reducing mental load (including competing priorities, emotional wellbeing, and family influence).