title: Social and Environmental Barriers to Nutrition Therapy for Diabetes Management Among Underserved Pregnant Women: A Qualitative Analysis.
abstract: OBJECTIVE
  To identify social and environmental barriers to nutrition therapy for diabetes management during pregnancy among a population of low-income, minority pregnant women.
  
  
  METHODS
  Prospective, in-depth, semi-structured interviews performed serially during pregnancy and continued until thematic saturation was reached.
  
  
  METHODS
  Urban academic medical center.
  
  
  METHODS
  Ten pregnant low-income, minority women with gestational diabetes and type 2 diabetes mellitus.
  
  
  METHODS
  Social and environmental barriers to nutrition therapy for diabetes management during pregnancy.
  
  
  METHODS
  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
  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.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: lynn.yee@northwestern.edu.
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Yee
authors.affiliation: Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Jamie M
authors.initials: JM
authors.lastname: McGuire
authors.affiliation: Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Shaneah M
authors.initials: SM
authors.lastname: Taylor
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Charlotte M
authors.initials: CM
authors.lastname: Niznik
authors.affiliation: Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Simon
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D016640:Diabetes, Gestational / Q000628:therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D044623:Nutrition Therapy / Q000523:psychology* / Q000706:statistics & numerical data*; D011203:Poverty; D011247:Pregnancy; D011446:Prospective Studies
keywords: gestational diabetes mellitus; health disparities; medical nutrition therapy; pregnancy; type 2 diabetes mellitus